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Joint trauma system vital link to saving lives

U.S. Army Sgt. Megan Smith, 159th Combat Aviation Brigade medic, reviews a patient's medical records during a patient transfer in Afghanistan, July 2014. Smith is a Devils Lake, North Dakota native deployed from Fort Campbell, Ky. Medevac typically flies with two aircraft and a team of four and may include a fifth with an en route care nurse. (U.S. Air Force photo by Senior Airman Sandra Welch)

U.S. Army Sgt. Megan Smith, 159th Combat Aviation Brigade medic, reviews a patient's medical records during a patient transfer in Afghanistan, July 2014. Smith is a Devils Lake, North Dakota native deployed from Fort Campbell, Ky. Medevac typically flies with two aircraft and a team of four and may include a fifth with an en route care nurse. (U.S. Air Force photo by Senior Airman Sandra Welch)

U.S. Army Spc. Robert Moher, 159th Combat Aviation Brigade crew chief, stands by to deliver blood in Afghanistan, July 2014. Moher, a Harlem, N.Y. native, is deployed from Fort Campbell, Ky. Joint Theater Trauma System members ensure fresh blood is always on hand. (U.S. Air Force photo by Senior Airman Sandra Welch)

U.S. Army Spc. Robert Moher, 159th Combat Aviation Brigade crew chief, stands by to deliver blood in Afghanistan, July 2014. Moher, a Harlem, N.Y. native, is deployed from Fort Campbell, Ky. Joint Theater Trauma System members ensure fresh blood is always on hand. (U.S. Air Force photo by Senior Airman Sandra Welch)

BAGRAM AIRFIELD, Afghanistan (AFNS) -- A loud explosion hits close, shaking the dust from the walls. Sirens start going off and servicemembers run to check on everyone near the impact site. The 9-line report comes across the net. Helicopter rotors start spinning. The wounded receive their first care from a medic who also completes a Tactical Combat Casualty Care card. A medevac helicopter soon lands to take the wounded to a hospital. While in flight, the medical team generates a Patient Care Record and later fills out an After Action Report.

These forms are the first step in data flow to the Joint Theater Trauma System. JTTS team members gather data from combat medical records and upload the data into a registry for analysis by teams in the U.S. The system is guiding developments of best practices across the military medical system including equipment enhancements to help prevent injuries and improvements in care. JTTS also has helped improve pre-hospital, patient movement, medical treatment facility, chronic care and lifelong rehabilitation.

"The data generated is scanned and uploaded into the globally viewable system," said U.S. Air Force Maj. Brandy Cox, JTTS trauma nurse coordinator, Kandahar Air Field, Afghanistan. "Trained data extractors enter the data into the Department of Defense Trauma Registry, this data is trended and researched to make vast improvements in the care and equipment provided to protect military members in theater."

This data would have not been available without the teams in theater. JTTS team members across the area of operation enter key points regarding a casualty's care with tools such as the TCCC card, which documents the casualty's wounds and treatment. Experts at Joint Base San Antonio analyze the information in order to generate updated best medical practice guidelines.

"We have published a Clinical Practice Guideline which is basically a playbook for all care providers throughout the area of responsibility on how to take care of these patients that you hardly see on the civilian side, such as high amputations or gunshot wounds to the head," said U.S. Air Force Maj. John Eggert, JTTS program manager, Bagram Air Field, Afghanistan. "Which most providers don't see on their day-to-day business but over here, unfortunately, we see more frequently."

Data from the system has helped military medical leaders improve the care of wounded. JTTS members also receive training on how to upload data to the registry before deploying.

"The teams in theater have attended a course conducted by the Joint Trauma System at Joint Base San Antonio. The Joint Trauma System members serve as the stateside subject matter experts on the trauma registry, combat casualty care performance improvement, and deployed trauma systems," said U.S. Army Col. Kirby Gross, Joint Theater Trauma System director, Bagram Air Field, Afghanistan. "Team members are trained on data extraction and forwarding of data to the Joint Trauma System for analysis. This permits rapid global access of information for near real time analysis permitting generation of reports and best practice guidelines soon after point of injury."

The JTTS has come a long way since inception. A team was first deployed to the area of operation in 2005 under the direction of the Central Command surgeon, U.S. Air Force Col. Douglas Robb. Then Col. Robb is now Lt. Gen. Douglas Robb, director of the Defense Health Agency.

"The original plan for JTTS derived from a civilian model trauma registry and has since blossomed from that model," said Cox. "Over the last decade plus, the complexity and concentration of our injured exceed the civilian model."

The success of the U.S. Central Command JTTS has prompted discussion of implementation of JTTS in other Combatant Commands. Data gathered by JTTS members and entered into the DoD Trauma Registry is used by other DoD organizations to improve survivability on the battlefield.

"The use of tourniquets has been mainstreamed and now has been adopted by our civilian counterparts, as well as the addition of junctional tourniquets for more involved extremity injuries," said Cox.

At the hospital, the next step in JTTS is collecting data from the wounded's medical records. When casualties are inbound medical personnel prepare the emergency room and wait for Dustoff. The hospital doctors and nurses meet with the flight medical team, upon arrival, and exchange information regarding treatment. The wounded receive care as the emergency department personnel document data on a Trauma Resuscitation form. Further care is captured in the form of doctor orders, progress notes and nurse notes. Then, people like Maj. Eggert and Maj. Cox enter key elements of these records into the registry for analysis and improvement of military treatment facility care.

"It is awesome to see patients whom were at such dire straits come so far and be able to live very productive lives, some even stay active duty," said Cox.

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