In April a broad coalition of trauma stakeholders met in Bethesda, Md., to begin implementing the recommendations of the landmark Zero Preventable Deaths report. The report, which was developed by the National Academies of Sciences, Engineering and Medicine (NASEM), proposes the creation of a joint civilian-military trauma system in the U.S. The goals are to maintain the readiness of military trauma teams and eliminate preventable trauma deaths in all settings.
Trauma System News recently interviewed Ronald Stewart, MD, FACS, chair of the ACS Committee on Trauma (COT), and Robert Winchell, MD, FACS, chair of the Trauma Systems Evaluation and Planning Committee of the COT. They talked about the practical challenges of implementing the ZPD vision.
Q. What top challenges were identified at the Zero Preventable Deaths conference?
Winchell: When the NASEM report was originally chartered, it was initially conceived as an effort to translate the lessons learned during our military experience in Iraq and Afghanistan back to the civilian world. But in June 2016 when the report came out, it was substantially different in that it focused very much on the vision of a joint national trauma system that combines the military and civilian systems — with an aspirational focus of “zero preventable deaths” whether on the battlefield or on the highway.
The challenge right now is not in disseminating the findings of the report so much as in operationalizing the findings. So the goal of the conference was to develop a framework and a consensus and a large stakeholder group to be able to do that. Dr. David Hoyt, as executive director of the American College of Surgeons, and the leadership of the Committee on Trauma all felt strongly that moving this initiative along was a very high priority. And we have dedicated ourselves to trying to make that happen.
Q. One big issue for the joint trauma system is governance. Did any decisions come out of the conference?
Winchell: I think it’s fair to say, both from a military standpoint and a civilian standpoint, that we all agree there needs to be a central, cohesive, high-level leadership with the commitment to move this joint national trauma system forward. I would say this kind of leadership has been the biggest vacuum on the civilian side, simply because I would argue there’s not been a lot of strong central governance on many policy things since 1776 probably.
So there is overall buy-in that central leadership of the joint trauma system is a good idea. The specifics get much harder. The NASEM report clearly placed the locus of civilian side leadership in the White House. And while most of us generally think that’s a good idea from an operational standpoint, it’s not easy. As you actually start talking to people in government, it becomes clear that there are plusses and minuses to almost any governance structure that one could put together. What ultimately happens will probably be a mixture of what we might theoretically conceive to be the best, what is practical within existing structures, and to some degree what is timely and fits with other priorities within those organizations.
Stewart: I think on the military side it’s easier because they’re used to a top-down governance system. And all the decisions in the military, you could argue, already flow from the president through the Department of Defense. The civilian trauma system has developed on a more local and regional level with the focus at the state or even county level. This system works well in many places, but leaves gaps across the country. I would favor federal support for infrastructure and standards that are implemented at the regional level.