Civilian–military partnerships essential for maintaining trauma competency

Demetrios Demetriades, MD, PhD, FACS
Demetrios Demetriades, MD, PhD, FACS

Significant progress has been made in civilian and military trauma care in the last two decades, with many advances attributable to knowledge gained during recent global wars on terror. Despite these advances, the current system of trauma training is not sufficient, according to Demetrios Demetriades, MD, PhD, FACS, professor of surgery and director of trauma, emergency surgery, and surgical critical care, University of Southern California (USC), Los Angeles.

Dr. Demetriades will discuss the need for improved trauma care training during Tuesday’s annual Excelsior Surgical Society/Edward D. Churchill Lecture, Civilian and Military Trauma: Training to Successfully Intervene and Save Lives.

“The widespread introduction of trauma centers and trauma systems has been a great achievement in improving trauma care,” he said. “However, the recent uncontrolled and largely unregulated proliferation of trauma centers—driven by profits and ambitions of individual health care organizations, rather than needs—has now become a major setback in trauma care and trauma training.”

During Tuesday’s award lecture, Dr. Demetriades will draw on his experience and lessons learned from the creation of the Los Angeles County (LAC)+USC U.S. Navy Trauma Training Center (NTTC) to highlight the importance of formalized civilian–military partnerships in maintaining trauma competency for military medical personnel and to boost advances in civilian and military trauma care.

“Training in operative trauma is a major challenge for the younger generation of surgeons in both civilian and military [settings],” Dr. Demetriades said. “The operative experience has been diminishing over the last few years in most trauma centers because of changing trauma epidemiology, the widespread use of nonoperative management for both blunt and penetrating trauma, advances in interventional radiology, resident work-hour limitations, and the limited exposure to trauma between wars for military surgeons.”

This is where civilian/military partnerships have an important role to play, he said, citing a 2016 report from the National Academies of Sciences, Engineering, and Medicine, stating that, “Sustaining needed expertise and capacity in the military trauma care system is simply impossible absent integration with civilian trauma care systems.”

The American College of Surgeons and the Department of Defense established the Military Health System Strategic Partnership program to establish and formalize partnerships with civilian academic and large, Level 1 trauma centers, with a focus on maintaining professional competency for military medical personnel.

The U.S. has five primary military–civilian training platforms, including the LAC+USC NTTC. The biggest obstacle in establishing these programs, Dr. Demetriades said, is bureaucratic red tape.

“It’s important that key political, academic, and military leaders establish an effective fast-track process,” he said. “Formalized civilian and military partnerships endorsed by the government, the military, the American College of Surgeons, and the American Association for the Surgery of Trauma are essential for maintaining trauma competency for military medical personnel and to boost advances in both civilian and military trauma.”

This lecture is named for the Excelsior Surgical Society, a group of 80 medical officers who met for the first time in 1945 at the Excelsior Hotel, Rome, Italy. The lecture also honors COL Edward D. Churchill, a famous surgeon and consultant to the U.S. Army in the World War II Mediterranean Theatre of Operations, who presented the first keynote address at the meeting.