The “Top 10” research and development priorities for battlefield surgical care: Results from the Committee on Surgical Combat Casualty Care research gap analysis

Abstract

BACKGROUND The US Military has achieved the highest casualty survival rates in its history. However, there remain multiple areas in combat trauma that present challenges to the delivery of high-quality and effective trauma care. Previous work has identified research priorities for pre-hospital care, but there has been no similar analysis for forward surgical care. METHODS A list of critical “focus areas” was developed by the Committee on Surgical Combat Casualty Care (CoSCCC). Individual topics were solicited and mapped to appropriate focus areas by group consensus and review of Eastern Association for the Surgery of Trauma (EAST) and Joint Trauma System guidelines. A web-based survey was distributed to the CoSCCC and the military committees of EAST and the American Association for the Surgery of Trauma. Topics were rated on a Likert scale from 1 (low) to 10 (high priority). Descriptives, univariate statistics, and inter-rater correlation analysis was performed. RESULTS 13 research focus areas were identified (eight clinical and five adjunctive categories). Ninety individual topics were solicited. The survey received 64 responses. The majority of respondents were military (90%) versus civilians (10%). There was moderate to high agreement (inter-rater correlation coefficient = 0.93, p < 0.01) for 10 focus areas. The top five focus areas were Personnel/Staffing (mean, 8.03), Resuscitation and Hemorrhage Management (7.49), Pain/Sedation/Anxiety Management (6.96), Operative Interventions (6.9), and Initial Evaluation (6.9). The “Top 10” research priorities included four in Personnel/Staffing, four in Resuscitation/Hemorrhage Management, and three in Operative Interventions. A complete list of the topics/scores will be presented. CONCLUSIONS This is the first objective ranking of research priorities for combat trauma care. The “Top 10” priorities were all from three focus areas, supporting prioritization of personnel/staffing of austere teams, resuscitation/hemorrhage control, and damage-control interventions. This data will help guide Department of Defense research programs and new areas for prioritized funding of both military and civilian researchers. LEVEL OF EVIDENCE Study design, level IV.

Evaluating the Tactical Combat Casualty Care principles in civilian and military settings: systematic review, knowledge gap analysis and recommendations for future research

“…Continued research is strongly recommended to better understand its role in prehospital and austere settings. 2 …”

“…In addition, a review conducted by Martin and colleagues highlighted gaps in battlefield casualty care research, including non-operative interventions for non-compressible truncal hemorrhage, the optimization of blood products and their storage, and factor concentrates and other alternative products for hemostatic resuscitation. 2 To our knowledge, no comprehensive knowledge synthesis describing the content and quality of current literature on the MARCH components of the TCCC guidelines has been performed. We sought to describe the current body of literature, evaluate its quality, identify gaps or potential limitations that exist within the TCCC guidelines, and offer recommendations for future research.…”

“… 1 This evidence base is reviewed monthly by the Committee on TCCC to identify MARCH interventions currently being used or any that with potential applicability to prehospital environments. 2 While these interventions are regularly reviewed, the overall body of literature is infrequently evaluated. Gap analyses are scarce.…”

“…Historic military medical data were reviewed and identified the most common and preventable causes of death on the battlefield: hemorrhaging extremity wounds, tension pneumothoraces and obstructed airways 1. Furthermore, the guidelines consider the added challenges of providing prehospital trauma care in an active military environment, such as delayed evacuation, poor visibility, and limited access to medical supplies 1 2. These factors inspired the five MARCH components within the TCCC guidelines: (1) massive hemorrhage control; (2) airway management; (3) respiratory management; (4) circulation; and (5) hypothermia prevention 1…”

Maintaining vascular trauma proficiency for military non-vascular surgeons

“…Military trauma is significantly different from civilian trauma, with different wound patterns and different resources for the deployed surgeons. [1][2][3][4][5][6] Surgical skill maintenance is a top priority within the military medical community. With active-duty, memory-of-combat casualty care fading when combat operations eventually cease, the ability to maintain a certain degree of surgical readiness will become even more of an issue.…”