Every year, as many as 30,000 people in the United States die of what is considered preventable trauma, according to a 2016 report from the National Academies of Sciences, Engineering, and Medicine (NASEM).
The solution cited in the study is treating civilian trauma care more like military trauma care — standardized, streamlined and immediate, with greater intensive care applied at the site of injuries.
A decade later, a team of San Antonio researchers is putting that solution to the test with help from a University of Texas System initiative, Trauma Research and Combat Casualty Care Collaborative (TRC4) program, which has funded the project.
TRC4 is a collaborative initiative dedicated to transforming trauma care for both military and civilian populations. The program funds innovative, inter-institutional research across the University of Texas System and partnering organizations, with a focus on rapidly translating discoveries into improved outcomes for service members, veterans and civilians.
By fostering partnerships between academic institutions, military medical centers and industry, TRC4 accelerates breakthroughs in trauma prevention, treatment and recovery — advancing care in Texas and beyond.
Waiting for an ambulance
Known as “Zero Preventable Deaths in Texas: 75th Ranger Regiment Principles Adapted for Statewide Law Enforcement Implementation,” the project launched in October.
With $500,000 in funding, the two-year initiative will bolster the immediate medical care patients receive at the scene of an injury and track patient outcomes.
Every day, about 58 people die from injuries and violence in Texas, said Taylor George, a doctor of public health who holds a master’s in health science, and a senior medic at the Texas Department of Public Safety (DPS).
“The majority of those deaths occur while patients are waiting for an ambulance or en route to the hospital,” George said.
“Through our (DPS) internal review and analysis, it has become clear to us that law enforcement personnel can and do save lives by providing Point of Injury/Illness emergency medical aid, oftentimes prior to arrival of traditional Fire/EMS resources,” George added. “Our project looks to gather the scientific evidence needed to refine and enhance this critical capability as part of a truly interoperable, scalable and applicable public safety ecosystem.”
The research team includes scientists from DPS, the Joint Trauma System and UT San Antonio.
George will serve as the principal investigator on the project. The team also includes these co-principal investigators and key advisors:
- Mark Escott, MD, chief medical officer, Texas Department of Public Safety
- David Wampler, PhD, professor and director of clinical research in the Department of Emergency Health Sciences; School of Health Professions, UT San Antonio
- Jeffrey Howard, PhD, professor, Department of Public Health, UT San Antonio
- Russ Kotwal, MD, MPH, director of strategic projects, Joint Trauma System
- Robert Mabry, MD; Brian Eastridge, MD; Clint George, DVM; Jason Pickett, MD; John Dominguez, SO-ATP, and Wren Nealy, EMT-P, as advisors
Kotwal emphasized the scale of the problem, noting that more than 60% of civilian and nearly 90% of military trauma deaths occur prior to hospital arrival.
“Time to required care is paramount for the critically injured,” he said. “Early care can be the difference between life and death.”
Adapting military medicine
The project’s innovation lies in its effort to translate trauma practices from elite military operations into the civilian sector.
The research is specifically based on the principles used by the U.S. Army’s 75th Ranger Regiment, which has successfully achieved near-zero preventable deaths in combat.
“On the battlefields of Afghanistan and Iraq, the U.S. military’s 75th Ranger Regiment substantially reduced its case fatality rate and demonstrated the life-saving potential of a whole-community approach to prehospital care,” Kotwal said.
The Rangers’ success is attributed to five key principles: ownership, culture, expertise, data/metrics and performance improvement.
To adapt this model, the team is proposing a paradigm shift in civilian trauma care that they call the “FAST 5s,” which calls upon first responders to “fix all simple trauma” within the first five minutes.
This involves training and equipping law enforcement officers to immediately apply the MARCH algorithm, or the 5s (massive hemorrhage, airway, respiration, circulation and hypothermia/head injury), a simple assessment and treatment process pioneered by the DoD’s Tactical Combat Casualty Care program.
“Bleeding and hemorrhage are major issues in trauma in both the military setting and the civilian setting,” Howard said. “Stopping blood loss — and just as important is replacing blood — is key.”
The lessons from military trauma care about blood products, such as the use of whole blood, are now being translated to civilian systems across the country, Howard said.
“From the military to law enforcement and from battlefields to our local communities, translating combat casualty care efforts and lessons learned are a silver lining of war that will save lives in Texas and beyond,” Kotwal said.
Data and performance improvement
UT San Antonio’s primary role in the research is to provide the expertise in data science necessary to prove the new approach actually works.
The team plans to create a first-of-its-kind database with critical information on medical interventions performed by law enforcement personnel at the scene.
The Law Enforcement First Responder Registry will be a companion to the Joint Trauma System registry, ensuring data validity and interoperability between military and civilian emergency care.
“The main thrust of this is constructing the data repository, constructing the database and getting all of the processes in place to feed the data,” Howard said.
The final phase of the project, a performance improvement effort, will rely on the new registry to analyze and compare outcomes. The goal is to provide an analysis of and comparison between the health outcomes of victims who receive or do not receive law enforcement medical intervention before first responders arrive.
With this evidence, the project aims to fundamentally change clinical practice and trauma policy across the state.
The team expects the initiative to serve as a blueprint for similar models other states can adopt, furthering the national effort to bring preventable trauma deaths to zero.
