Contact: Will Sansom
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E-mail: sansom@uthscsa.edu

Speaking at a San Antonio Trauma Symposium press conference are (left to right) Cmdr. Joseph Rappold, M.D., of the Naval Medical Center in San Diego; Col. John B. Holcomb, M.D., of the U.S. Army Institute of Surgical Research at Fort Sam Houston; and Ronald Stewart, M.D., of The University of Texas Health Science Center at San Antonio and University Hospital.
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The 13th Annual San Antonio Trauma Symposium, which took place Aug. 20-22 at the Henry B. Gonzalez Convention Center, served as a platform to promote emergency and trauma care awareness on a national level, particularly the need for more research dollars to be devoted to this critical area of medicine.

The National Trauma Institute (NTI) presented the symposium along with Navy Medicine. The NTI represents the partnership and combined resources of The University of Texas Health Science Center at San Antonio, Brooke Army Medical Center, Wilford Hall Medical Center, the U.S. Army Institute of Surgical Research and the University Health System.

NTI goal is to initiate national research effort
Trauma costs the nation $406 billion annually and is the leading cause of death in persons age 1 to 44. It results in 16,000 deaths annually in Texas. The NTI expects to mobilize a nationwide research effort to minimize trauma-related deaths, medical costs and loss of productivity.

Collaboration will improve trauma care
Trauma care improves as the military and civilian sectors learn from each other, speakers said. Medically, the procedures to care for a wounded soldier in Iraq are the same as the procedures to care for a crash victim on a San Antonio roadway. Treatment innovations from Operation Iraqi Freedom and Operation Enduring Freedom are expected to benefit civilian trauma systems.

“Trauma is a national health care disaster of epidemic proportions,” said Col. John Holcomb, M.D., commander of the U.S. Army Institute of Surgical Research and an NTI board member. “There have been 30,000 casualties and 3,300 deaths so far in the global war on terrorism. Anything we learn on both sides, civilian and military, will help the other side.”

Because of new innovations now in routine practice, the fatality rate per case in Iraq and Afghanistan is half that of Vietnam, Col. Holcomb said.

Applying wartime treatment strategies can save civilian lives
Traumatic injuries result in 37 million emergency room visits, 2.6 million hospital stays and more than 160,000 deaths in the U.S. annually. This dramatically shows the need to apply lessons learned in wartime to the care and prevention of injuries here at home, said NTI board chairman Ronald M. Stewart, M.D., associate professor and chief of the trauma surgery division at the Health Science Center and trauma medical director at University Hospital.

Trauma research receives less funding
For every $3.51 of federal funds spent on HIV research and $1.65 on cancer, only a dime is spent on injury research (per year of potential life lost per 100,000 population). “The NTI’s goal is to bring attention to the need to do more to decrease traumatic injuries throughout the U.S.,” Dr. Stewart said.

Getting soldiers the right care
Col. Brian Eastridge, M.D., trauma director at Brooke Army Medical Center and NTI board member, spoke to reporters via satellite phone from Iraq, where he is directing trauma care in the war theater.

He said civilian trauma care experience has influenced combat evacuation doctrine in Iraq and Afghanistan. In the current war, soldiers are being flown directly from the point of injury to large trauma centers in hospitals, rather than to multiple layers of care (forward surgical team, combat support hospital, etc.) as in previous conflicts.

“The bottom line,” he said, “is to get the right patients to the right resources to get the right care.”

Civilian research has shown that hypothermia is a problem in the injured, even in the desert. This is being minimized in the war theater, Col. Eastridge said.

Experience in the war theater has shown that combat tourniquets save lives 90 percent of the time if appropriately placed, but only 60 percent of the time if inappropriately placed. Proper placement is being emphasized.

In addition, the concept of “damage control resuscitation” is being used to enable blood pressure of the injured to remain low and fluids to be given in parallel versus serial fashion. This approach is reducing mortality from 50 percent to 20 percent in cases in which it is used.

The military trauma care personnel also are using a Factor 7 drug that is showing a 10 percent increase in survival with no evidence of increased complications.

Wartime innovations will be used for civilians in the future
Because of these innovations, the current war has the lowest mortality rate of any major conflict, less than 9 percent. “The techniques used in the battlefield today will be in use in San Antonio and other cities in the not-too-distant future,” Col. Eastridge said.

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The University of Texas Health Science Center at San Antonio is the leading research institution in South Texas and one of the major health sciences universities in the world. With an operating budget of $576 million, the Health Science Center is the chief catalyst for the $14.3 billion biosciences and health care sector in San Antonio’s economy. The Health Science Center has had an estimated $35 billion impact on the region since inception and has expanded to six campuses in San Antonio, Laredo, Harlingen and Edinburg. More than 22,000 graduates (physicians, dentists, nurses, scientists and allied health professionals) serve in their fields, including many in Texas. Health Science Center faculty are international leaders in cancer, cardiovascular disease, diabetes, aging, stroke prevention, kidney disease, orthopaedics, research imaging, transplant surgery, psychiatry and clinical neurosciences, pain management, genetics, nursing, allied health, dentistry and many other fields.