Appendix3.pdf

Theatre Joint Trauma Record

Appendix 3

Theater Joint Trauma Record

General

Evidence-based medicine has become the goal of all specialties.

Unfortunately, because of the realities of Combat Trauma, timely

and accurate data collection and interpretation of results are

difficult. Quality information on casualties for combatant

commanders is essential because it facilitates optimal placement,

utilization, and resupply of scarce medical resources, and rapid

identification of new trends in wounding and treatment.

Accurate, aggregated theater information is necessary to shorten

quality improvement cycles in deployed treatment facilities.

Furthermore, these data placed on a website could provide rapid

feedback to the sending physicians, allowing individual follow-

up on their patients. These concepts are not new: they are

routinely employed in the > 1,000 verified trauma centers in

the US. Application of these principles to the battlefield, using

a limited set of jointly approved data elements is described

below. This data collection effort is not designed to be an extra

step. The proposed form can be used as the trauma chart (both

battle and nonbattle injury) and sent to the next evacuation Level

with the casualty.

Situational Awareness

The revolution in warfighting which has digitized the battlefield

to display friendly positions, intelligence, and engagements

electronically has not been equally applied to the casualty side

of the equation. This places demands on medical organizations

to provide online and continuously updated status and location

information on killed, wounded, ill, and psychologically

impaired combatants and noncombatants; which includes both

the casualty loss to the unit and the return to duty patient. This

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Emergency War Surgery

need will only escalate, as medical situational awareness plays

an increasing role in the tactical risk assessment process. At a

minimum, commanders should be able to assess Killed In Action

(KIA, died before reaching medical care/force wounded) and

Died Of Wounds (DOW, die after reaching medical care/force

wounded) in order to measure risk associated with operations

and the capability of the medical force to control mortality.

No. killed before reaching a BAS 100

No. of casualties (killed + admitted)

Percentage KIA =

No. died after reaching a BAS

Percentage DOW =

100

No. of admitted

Where admitted is defined as any casualty that stays at a

Level II facility or above. These definitions do not include

the carded for record category in the denominator.

A breakdown of casualties by type of injury and the major body

regions (ie, face, head and neck, chest, abdomen and pelvis,

upper and lower extremities, and skin) will enable an analysis

of injury patterns that can be utilized to design interventions

resulting in a decrease in morbidity and mortality.

Other Uses

Data on types of wounds, their causes, and appropriate

procedures have potential value in constructing predictive

models for medical force development and placement, logistical

delivery systems, and research on improved medical interven-

tions. The history of improvements in medicine and surgery

are grounded on the battlefield, and dissemination should not

be limited to the isolated innovator with a personal spreadsheet

for documentation. Individual providers at individual medical

treatment facilities (MTFs) have long recorded clinical data and

observations. This Joint Theater Trauma Record effort is an

extension of their efforts.

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Theatre Joint Trauma Record

Minimum Essential Data

In addition to recording the standard contents of the postprocedure

note (ie, who did what, on whom, why, and a plan), the standard

data components of a trauma registry are especially helpful (eg,

demographics, circumstance and mechanism of injury, pre-

hospital monitoring and care, hospital monitoring and care,

outcome, participants, direct assessment against standards).

Figure A-1 (see next four pages) is a sample form that can serve

as both the trauma chart and the data entry source. These

minimum essential elements have been agreed on by the US

Army, Air Force and Navy. Data will be collated and placed on

a website at the first Level IV facility in the evacuation chain.

Recommended Methods and Technology

The process to document emergency trauma care can be

employed on either the immature or mature battlefield. This

would entail utilizing paper or computer-assisted electronic

technology, respectively. In the ideal environment, this would

be a single step process. Reality is much different. It is important

to recognize that documentation should occur at all Levels, while

aggregation of data should occur at the first Level that can

support such activity. At a minimum, paper documentation

should be used for each casualty and the chart should

accompany the patient to the rear as evacuation occurs. When

electronic records are available, this process will be simplified.

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Theatre Joint Trauma Record

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