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

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Guidance Clinical

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