Look to war zones to improve trauma care, St. Louis doctor writes in national report
It took too long for blood supplies to get to Baghdad, so Dr. Philip Spinella and his Army colleagues gave their own blood. To their surprise, it worked better.
“We started to use whole blood, out of our arms into the casualties,” said Spinella, who served as an Army doctor between 1995 and 2007. “Their shock would resolve, their bleeding would resolve a lot quicker than just using plasma and red cells that we had shipped from home.”
Whole blood transfusion would later become the focus of several academic studies, an example of how experience on the front lines can lead to improvements in trauma care for civilians. But despite such advancements, as many as one in five deaths from traumatic injuries like car accidents and gunshot wounds could be prevented with better care, according to a report released Friday by the National Academies of Science, Engineering and Medicine. Spinella is one of 20 committee members to author the report.
In 400 pages and 11 formal recommendations, the authors suggest that the White House establish a national trauma system that includes both civilian and military health providers.
“If the current course of trauma care continues, the consequences will be dire for tens of thousands of trauma patients who deserve, and could have, better outcomes,” the committee concluded. “The problem is of such magnitude and the current systems are so fragmented that the committee believes action and leadership are needed at the highest levels of the White House.”
It's been more than a decade since doctors, nurses and administrators started donating their own blood in Army hospitals. But Spinella, now a critical care doctor at St. Louis Children’s Hospital, believes the U.S. health care system is at risk of losing the institutional knowledge gained during the wars in Iraq and Afghanistan.
Spinella said the frequency of mass shootings, such as the one this week at a night club in Orlando that killed 49 and injured dozens more, show that hospitals need to be prepared.
“Orlando was a regular day in Baghdad … and we don’t have the systems here, to deal with that magnitude. Over time, we’ll lose the experience,” Spinella said. “Even if [doctors] have the knowledge, they don’t have the equipment.”
The recommendations cover all components of the trauma care system: paramedics, emergency room doctors, surgeons, intensive care units and rehabilitation.
Injury and violence kill about 200,000 people a year in the United States, according to the Centers for Disease Control and Prevention. Unintentional injury is the leading cause of death for Americans between the ages of 1 and 44. But trauma care research often lags behind other specialties, Spinella said, often due to a lack of funding and the difficulty of conducting clinical trials in emergency situations.
“The urgency here is that there are so many potential lives that could be saved now,” Spinella said, estimating that 30,000 trauma-related deaths could be prevented each year with better care. “That’s a lot of low hanging fruit.”
Follow Durrie on Twitter: @durrieB.