Tammy Duckworth and Patrick Downes: Better Trauma Care Would Prevent Death

A decade apart, it only took an instant to change both of our lives forever. In 2004, one of us was piloting a Black Hawk over Iraq, doing what she loved when a rocket-propelled grenade hit the helicopter, vaporizing one leg and slamming the other into the helicopter’s instrument panel—instantly amputating it.

Almost ten years later, the other one was celebrating a beautiful Patriot’s Day on the streets of Boston with his wife when an improvised explosive device set to explode at the finish line of the Boston Marathon blew off his leg below the knee.

These instants thrust our lives into the hands of skilled first responders and trauma experts in Iraq and Boston and, ultimately for us both, at the Walter Reed National Military Medical Center just outside of Washington, DC. As part of our recovery we both endured—and will continue to endure—countless surgeries, and we must remain dedicated to sustaining our physical and psychological health for the rest of our lives.

Thousands of other service members and Americans have gone through similar experiences, and even more have suffered traumatic injuries resulting from more commonplace—but equally damaging—experiences like car accidents and falls.

For those with traumatic injuries suffered in combat, as a result of terrorism or less sinister causes, access to the best medical equipment and techniques may be the difference between saving or losing a limb—or even between life and death. It’s not hypothetical either; trauma-related injuries are the leading cause of death among those 45 and under in the United States.

Throughout our long, often painful recoveries, we relied on talented professionals not only to keep us alive, but also to help support us. We are grateful and indebted to each and every one of them for their efforts to minimize the lasting effects of the injuries we sustained and empower us to continue living wholesome, purposeful and fulfilling lives.

Though we are appreciative of the excellent care we received, we also know that not every American has the same access. Because of training, experience and other factors, people in the civilian care system may not be treated with the same techniques honed by our military surgeons on the front lines. Conversely, military physicians do not treat enough trauma patients in peacetime to keep their skills sharp and ready for use when the nation calls upon them. The two trauma care systems simply don’t talk to or interact with each other enough, and they don’t have the same resources.

This lack of a unified national trauma system has severe consequences in terms of lives lost and costs for both civilians and servicemembers. Trauma accounts for almost half of deaths for those 45 and under and cost the economy over $670 billion in 2013. Even more alarming is that a significant number of these deaths may be avoidable if victims receive suitable treatment within a reasonable amount of time. The National Academies of Sciences, Engineering and Medicine estimates that with optimal care, as many as 20 percent of the 147,790 U.S. trauma deaths in 2014—nearly 30,000—could have been prevented.

The military is not immune to the scourge of preventable trauma deaths either. Despite advances in trauma care, up to 25 percent of battlefield deaths between 2001 and 2011 were a result of survivable wounds, translating into nearly 1,000 lives lost unnecessarily.

These statistics are staggering, and we must act with a sense of urgency to end this public health crisis. A streamlined National Trauma Care System would serve the practical needs of our citizens by bringing together the respective advantages in these two disparate, disconnected trauma systems. With better integration, all trauma providers would be empowered to maintain skills and share the latest techniques developed in military and civilian medical centers to reduce preventable death and injury from trauma. That’s why we crafted the National Trauma Care System Act to integrate civilian and military trauma care systems to ensure all trauma providers and patients benefit from the latest advanced techniques and technology developed on the battlefield and in our nation’s hospitals.

In June 2016, NASEM published a report, A National Trauma Care System: Integrating Military and Civilian Trauma Systems to Achieve Zero Preventable Deaths After Injury. If enacted, this legislation would establish a pathway to realize NASEM’s vision of a “national trauma care system grounded in learning health system principles applied across the continuum of care, from point of injury to hospitalization, rehabilitation, and beyond.”

The bill also recognizes that successful real world examples of trauma care improvement exist and that these best practices must be widely shared. The 75th Ranger Regiment of the Army nearly eliminated its preventable fatalities by implementing data-driven performance improvement policies and taking command-ownership of treatment outcomes. Accordingly, to achieve the ultimate goal of zero preventable trauma-related deaths, the National Trauma Care System Act promotes standardization of trauma care across the nation and military, establishes common data standards, places military trauma teams into civilian trauma centers and enhances trauma research coordination.

Every single one of us deserves the best care available, especially in light of the terrible attacks on civilians we’ve seen in recent months, whether in Orlando, San Bernardino, New York and New Jersey or elsewhere. Of course, as we continue to root out hate and recommit ourselves to the fight against terrorism in all its forms, we should also work to improve our nation’s trauma care system so that no survivor ever again faces increased risk of injury or death simply because of gaps in our nation’s trauma care network.

Like too many Americans, we can both testify to the life-shattering experience of trauma, but also to the enormous healing power of caring and dedicated clinicians and communities. An integrated, streamlined National Trauma Care System would get us closer to where we need to be, and it would help ensure all who come after us have the best chance of not only surviving, but also of leading long, healthy and fulfilling lives.