THOR RDCR Symposium Col Michael Davis US CCCRP Director June 26, 2017 US Combat Casualty Care Research Program
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THORRDCRSymposium
ColMichaelDavisUSCCCRPDirectorJune26,2017
USCombatCasualtyCareResearchProgram
CombatCasualtyCareResearchProgramDr.DavidBaerDr.BonnieWoffendenDr.ThereseWestDr.SavitaNigamDr.AnneRiJerDr.CrystalHill-PryorDr.ArthiAminMs.ElisabethFlessnerMs.TeresaHendricksonMs.AndreaSteeleMs.IreneTaliaferro
LTCDavidJohnstonCol(sel)AntoineJeShinnDr.TammyCrowderDr.MarcelloPiliaMr.RonPalmerMr.RobertSarvaideoMs.CindyEndicoJMr.RaminKhaliliMs.ClaudiaLarinMs.NsiniUmohMs.KamilahBrown
Acknowledgments
Overview
• StructureofCCCResearchProgram
• Reviewofnewguidance&guidancedocument
• Linesofeffort&newiniXaXveswithinthese: 1.Streamlineinternalprocesses2.Clinicalrelevanceinallwedo3.Makeuseofstrategicpartnerships4.Forwardleaningscien?ficexcellence
• Strategy-Mission,StrategicVision
• CCCRPisarequirements-driven,medicalresearch&developmentprogram– chargedtoplan,program,budgetandoverseetheexecuXonofaDoDRDT&Eequitydedicatedtothetopicofmilitarytraumaorcombatcasualtycare.
• Vision:OpXmizesurvival&recoveryfromcombatrelatedinjuryincurrent&futureoperaXonalscenarios
• Mission:DrivemedicalinnovaXonthroughdevelopmentofknowledge&materielsoluXonsfortheacute&earlymanagementofcombatrelatedtraumaincludingpointofinjury,en-route&facilitybasedcare.
CombatCasualtyCareResearchProgram
MilitaryMedicalResearch
Rasmussen,T.E.,Baer,D.G.,Doll,B.A.&Carvallo,J.(2015).GoldenHour.ArmyAL&T
CCCRPPor`olioStructure
AsmaJeroforganizaXon,theinvestmentalignswithphysiologicsystemsorlocaXonsofcare
JPC-6 Combat Casualty Care Research Program
En-route Care
Neuro-trauma
Forward Surgical Intensive Care
Hemorrhage Resuscitation
• GuidedbysteeringcommiJeecomprisedofjointservicereps,SMEs,combat&advanceddevelopers,CoEs,serviceconsultants
Informed&MulX-DisciplinaryPor`olios
Medical Photonic
• Managersconforminvestment(PAs,BAAselecXon,RFPs)accordingtorequirements&steeringcommiJeedirecXon
• ManagerscoordinatewithADtochairorco-chairWGsorIPTs
DHA
MRMC
Coordinated, programmed, Joint research
ARMY
Extramural & Intramural
Army LABs
IntegratedResearchProgram
Program Area Directorate
(PAD-2) Approximate $28M*
Joint Program Committee
(JPC-6) Approximate $91M*
*estimates not for official use
ImperaXveforCombatCasualtyCare
NaXonalAcademiesofSciences,Engineering,andMedicine.ANaXonalTraumaCareSystem:IntegraXngMilitaryandCivilianTraumaSystemstoAchieveZeroPreventableDeathsAcerInjury.Washington,DC:TheNaXonalAcademiesPress,2016.doi:10.17226/23511.
PartnershipwithNASEM&NEJM
“AsImportantaswhatthemilitary’slearninghealthsystemproducedishowtheseadvancesweremade–throughfocusedempiricismalignwithrequirements-driven,life-cyclemedicalresearchanddevelopment”
ClinicalRelevanceoftheResearchProgram
• ComponentsofMilitary’sLearningHealthSystem-Data-drivenperformanceimprovement(cultureofPI)-Requirements-drivenmedicalresearch&development-Agile,evidencesupportedclinicalpracXceguidelines
• ConceptofFocusedEmpiricismlinkingdata,pracXce&performanceimprovement
Drive medical innovation through development of knowledge and materiel solutions for the acute and early management of combat-related trauma, including point-of-injury, out-of-
hospital, and facility-based care.
Science
Service Member Service Member
Hemorrhage Control and Resuscitation
THREATS
Non-CompressibleBleeding
ImpairedBloodCloIng
LimitaKonsonBloodProduct
Supply
Prolonged/DelayedMedical
EvacuaKon
Pre-Hospital Tactical Combat Casualty Care
THREATS
TraumaKcBleeding
CardiovascularDecompensaKon
TraumaKcAirwayObstrucKonand
TensionPneumothorax
Pain
MassCasualKes
Prolonged/DelayedMedicalEvacuaKon
Neurotrauma & Traumatic Brain Injury
THREATS
Moderate/SevereTraumaKcBrain
Injuries
Blast-RelatedConcussions
Prolonged/DelayedMedicalEvacuaKon
Forward Surgical, En Route, and Critical
Care THREATS
BurnInjuries
MulKple-OrganFailureandInfecKon
ComplexInjuriesinvolvingBone,Nerve,andSoW
Tissues
LungInjuries
Combat Casualty Care Research Program (CCCRP) Mission and Focus Areas
PlanAccordingtoRequirements
January - March 2015
PlanComesfromRequirements
PlanforResearchComesfromData
J Trauma Acute Care Surg 2012;73(Suppl1):S431-S437
• Of4,596warXmecasualXes,87%occurredinprehospitalsenng;ofthose,76%non-survivablebut24%(N=976)werepotenXallysurvivable…
PlanforResearchComesfromData
J Trauma Acute Care Surg 2012;73(Suppl1):S431-S437
91% from hemorrhage
PlanforResearchComesfromData
J Trauma Acute Care Surg 2012;73(Suppl1):S431-S437
Truncal
Extremity
JuncXonal
2016DCASStudyofCasualtyCareinAfghanistan&Iraq
• AnalysisofMortalityDuringRecentWars:CaseFatalityRatehasdecreasedbutDiedofWoundshasincreasedComparedtoVietnam.NessenSC.
“AnalysisshowsincreaseinDOWratesinOIF&OEFcomparedtoVietnamandhighermortalitycontrastedtomatchedciviliantraumapaXents.ConsideringtheresourcelimitaXonsofOIF&OEF,theseoutcomesmaybeacceptable.However,consideringit’sunlikelyampleresourceswillbeavailableinfuturemilitaryconflicts,effortsmustbemadetoopXmizecasualtycareinresourceconstrainedenvironments.”
2016DCASStudyofCasualtyCareinAfghanistan&Iraq
“Aboveall,wemustnotallowourselvestofightthenextwarbasedonexcessivelyopXmisXcassumpXonsaboutourcapabiliXesinthepastwar.”NessenSC,etal.
CCCResearchProgramForward-leaningS&TtodeliversoluXonsforfutureandmorecomplexscenarios(newfocusofDASA(R&T)- RefocusS&Teffortstomid-
term(recapitalizaXon)
18 January 2017
- ProlongedFieldCare&EndovascularResuscitaXon
- FocustowardsAI,automaXon,decision-support,tele-enabledcare&miniaturizaXon
- New$(15%overPOM)for2newtasks
AnXcipaXngtheCharge
J Trauma Acute Care Surg 2015;79(4):S61-S63
CombatCasualtyCareResearchProgram
J Trauma Acute Care Surg 2015;79(4):S61-S63
AnXcipaXngtheCharge
• Newgoldenhourcapabilityfocusedonphysiologynotusualfixedechelonsofcare
• UnmannedcasualtyevacuaXon– InsenngofMulX-domainBaJlefield,PFC– Decisionsupport/automatedsystems/tele-intervenXon
• HBOCs/oxygencarriers
• Organsupport/ECLS
AnXcipaXngtheCharge
ThankYou
“exscien?aadbellum”-fromsciencetothebaOlefield
CCCResearchProgram
• StrategicLinesofEffortClinicalrelevanceinallwedo-ensureinnovaXonbenefitstheinjured(JTS&otherclinicalcommuniXes)
CCCRP
USU
NA
MR
U
Arm
y RA
D &
Labs
AF 711
th HPW
Defense H
ealth Program
AF 59
th MW
MT
Fs / CI Clinical
Guidance Clinical
Questions
DCoE DCoE
NM
RC
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