Military and Civilian Collaboration: The Power of Numbers

Abstract

The purpose of this study was to compare the number and types of extremity injuries treated at civilian trauma centers (CIV CENs) versus military treatment facilities (MTFs) participating in the Major Extremity Trauma Research Consortium (METRC) and to investigate the potential benefits of a clinical research network that includes both civilian trauma centers and MTFs. Two analyses were performed. First, registry data collected on all surgically treated fractures at four core MTFs and 21 CIV CENs over one year were compared. Second, actual numbers and distribution of patients by type of injury enrolled in three METRC studies were compared. While MTFs demonstrated higher percentages of severe injuries including open fractures, traumatic amputations, vascular injuries, contamination, and injuries with bone, muscle, and skin loss when compared to CIV CENS, the CIV CENs treated a substantially higher number and, more importantly, enrolled patients in almost all categories. Comparison of service members to civilians was challenged by several differences between the two patient populations including mechanism of injury, the medical care environment, and confounding factors such as age, social setting and co-morbidities. Despite these limitations, in times without active military conflict, clinical trials will likely rely on civilian trauma centers for patient enrollment; only when numbers are pooled across a large number of centers can requisite sample sizes be met. These data demonstrate the benefits of maintaining a military-civilian partnership to address the major gaps in research defined by the Military.

Facilitators and constrainers of civilian–military collaboration: the Swedish perspectives

“…Research and clinical practice between both partners are needed to establish best practices for treating severely injured military and civilian population, including other important areas such as triage, the concepts of anesthesiologic and surgical damage control, etc. [2,45,51]. Equally important is the exchange of lessons learned in both organizations as a foundation for developing new technologies and improved treatment strategies to be used in subsequent conflicts [45].…”

“…[2,45,51]. Equally important is the exchange of lessons learned in both organizations as a foundation for developing new technologies and improved treatment strategies to be used in subsequent conflicts [45].…”

“…Although different etiology, the extremity injuries are common in both civilian and military setting. While most of the civilian injuries are caused by blunt trauma, over 80% of extremity injuries in a combat are caused by blasts and high-velocity gunshot wounds [44][45][46]. Blast injuries are caused by rapid pressure waves created by the detonation of explosives and cause multisystem, life-threatening injuries in single or multiple victims simultaneously.…”

“…While military surgeons manage most complex injuries, they may have less training in times of low military casualty flow. Civilian surgeons, on the other hand, have a higher rate of civilian injuries, but less knowledge in treating complex combat injuries [45].…”

Direct enhancement of readiness for wartime critical specialties by civilian-military partnerships for neurosurgical care: residency training and beyond

“…Their purpose is to disseminate battlefield knowledge and techniques "in civilian practice, so they are available during future conflicts." 14 However, one of the major limitations of the contributions from MTFs to this database is the significantly higher volume of patients seen at civilian centers, which can be nearly 11 times the comparative volume of an MTF, 24 highlighting the continuing need for civilian collaboration to advance military medicine and vice versa. A similar model should be applied to the field of neurosurgery, so that the lessons learned through the precious sacrifices of our service members can be carried forward to benefit others in the future.…”