Military Medicine Comes Home

In the wake of the Orlando shootings, many are calling for closer ties between military medicine and civilian casualty medicine.

Military medicine has made remarkable strides in reducing combat deaths. At the beginning of Operations Enduring Freedom (OEF) and Iraqi Freedom (OIF), the combat injury case-fatality rate was approximately 18%. Over the subsequent decade, it steadily decreased to 5% despite an overall increase in injury severity. This remarkable achievement is grounded in advances in all aspects of trauma care, from the point of injury to optimum treatment in military rehabilitation centers.

Now, the National Academy of Sciences, Engineering, and Medicine is calling for a national trauma care system to promote learning across the healthcare spectrum—from an injury scene to hospitalization, rehabilitation, and afterward.

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Unfortunately, mass shootings in the US have become commonplace and we need to adopt a combat care mentality to treat the casualties. As such, there are many opportunities to use education, training, transportation, triage logistics, and rehabilitation processes and technologies to reduce deaths and disability.

CPR education and the public availability of automated external defibrillators are examples of how public health interventions can be effective. “Heart experts at Johns Hopkins and elsewhere have evidence that at least 522 lives can be saved annually in the United States and Canada by the widespread placement of automated external defibrillators, the paddle-fitted, electrical devices used to shock and revive people whose hearts have suddenly stopped beating.” We might see similar results with publically available tourniquets specifically designed to stop bleeding.

The emergency management system has a lot to learn from military medicine. Unfortunately, the US has become a place where we need to learn those lessons sooner than later. It might be time for a new CCC: The Civilian Casualty Corps.