The Remote Trauma Outcomes Research Network: Rationale and Methodology for the Study of Prolonged Out-of-hospital Transport Intervals on Trauma Patient Outcome
ARMY INST OF SURGICAL RESEARCH FORT SAM HOUSTON TX
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The time elapsed between injury and hemostasis is inversely proportional to survival and functional recovery in the trauma patient.1,2 Yet, we remain largely naBve to the pathophysiologic sequence that unfolds during this critical time frame.3,4 Likewise, prolonged evacuations encountered by critically wounded combatants may pose similar hazards. Little room for improvement remains in hospital-based care, however,when one considers the 97 survival rate for casualties engaged by the Joint Trauma System.5 In contrast, the out-of-hospital and preoperative phase of care referred to asNATORole I represent perhaps our greatest opportunity to further reduce combat death.6,7 Ironically, many of the greatest advances in medical and surgical practice have occurred as a consequence of armed conflict. The impending resolution of contemporary conflicts in Iraq and Afghanistan is awelcome development, but with it will come a loss of the opportunity to observe, learn, and innovate while engaged in combat casualty care. Thus, if advances are to continue, it will be necessary to refocus existing clinical investigation networks engaged in battlefield care research and to seek a relevant setting other than war to continue this vital effort. The Remote Trauma Outcomes Research Network Rem TORN is the first and largest investigation to date of trauma patients undergoing prolonged preoperative treatment and transport. By providing a model complementary to the current deployed environment in terms of geospatial, temporal, and scope-of-practice characteristics, itmay enable rigorous and relevant studies of out-of-hospital care, new diagnostic and therapeutic approaches, and their collective effect on outcomes. Ultimately, it may enable the establishment of remote damage control resuscitation RDCR as a clinical practice.
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