Trauma Chief Cites Sweeping Changes in Critical Care

By Elaine Sanchez

Brooke Army Medical Center

JOINT BASE SAN ANTONIO-FORT SAM HOUSTON, Texas, Aug. 23, 2012 – From battlefield innovations to revamped health care systems, the military has radically transformed its trauma care over the past decade, a trauma expert here said.

These advances have led not only to the nation’s highest combat survivability rate in history, but also to countless saved civilian lives, said Air Force Lt. Col. (Dr.) Jeremy Cannon, the chief of trauma and acute care surgery at San Antonio Military Medical Center, which houses the Defense Department’s only stateside Level 1 trauma center.

Cannon summed up many of these sweeping improvements to military and civilian critical care in the August edition of the “Surgical Clinics of North America.” Serving as guest editor, the doctor called on a number of his military and civilian health care colleagues to contribute articles on recent advances, while offering insights from his experiences during three deployments in the past six years.

One of the most significant trauma care advances, he noted in the journal, was the introduction of regionalized trauma care, which involves a network of trauma centers in the same region working in coordination to save lives.

South Texas offers a perfect example of a smooth-running regional system, he noted. A network of area hospitals, including SAMMC, accepts trauma cases from smaller hospitals that may not be equipped to handle severe injuries. All work together to ensure patients receive optimal care, Cannon wrote.

The military adopted this civilian-based concept in combat, he added, implementing care that ranges from point-of-injury treatment to extensive surgery. By doing so, he explained, the military was able to take this concept downrange, “tweak it,” and feed it back to the nation with improvements.

Cannon also noted the introduction and growing popularity of “damage-control” surgery. This approach involves surgeons focusing on the most life-threatening wounds first, followed by other surgeries as time and the patient’s strength allow. Prior to this concept, he said, surgeons typically would “fix everything and close,” then adopt a “wait and see” approach. While this may be fine for some patients, the doctor said, it became evident, particularly with catastrophic combat casualties, that a multi-phased approach would better benefit some patients.

Wound management also has seen significant changes, Cannon said, noting the impact of vacuum-assisted dressings, a temporary closure that protects the organs while monitoring fluid output. These dressings, which allow stabilization of the wound, have eliminated the need to change gauze dressings several times a day, increasing patient comfort and enabling nurses to focus on other, more pressing aspects of care.

“It’s had an invaluable benefit to a tremendous number of patients,” he said.

Cannon also noted the major advances in en-route critical care, or taking a soldier from the point of wounding to definitive care. He attributes successes to a combination of long-range transport by critical care teams and advanced critical care therapies for “early acute organ failure.”

Additionally, cutting-edge technology has transformed the care provided in intensive care units, Cannon said, citing ultrasound equipment as an example. Bedside ultrasound imaging has “greatly enhanced the ICU toolkit for diagnosis, monitoring and interventional procedural guidance,” he said. These monitors, he explained, have become less invasive and better at pinpointing vital information.

Cannon points out these examples and many more in the journal, while also looking to even broader changes in the years ahead. The Joint Theater Trauma System, for example, will provide the framework for identifying future potential critical care needs. Through this system, doctors enter combat casualty data rapidly into the JTT Registry, which they can later mine for information regarding diagnoses and survival rates. Put simply, this information can be used to make better decisions regarding future care.

Cannon said he set out to chronicle lessons learned and to create a reference point for future generations to explain “why we do what we do.”

“It was an honor to be asked to do an update of such an important topic,” he said. “I hope it can serve as a benchmark for today’s trauma care.”