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Research FAQ's:

Despite huge advances in medicine and technology, trauma care has in many ways been stuck in the past century. A soldier wounded in Iraq will get resuscitated with the same salt solution that was used in Korea. Army doctors in Iraq have the same problems storing blood that plagued doctors decades ago. No one yet knows the best way to treat a head injury. And it is still unclear whether drugs can stem hemorrhage from internal bleeding. It's critical that research, education, critical care and injury prevention programs improve the treatment of trauma, and the key to this improvement is research.

1. Why does trauma and emergency care research need funding?
2. Has trauma and emergency care research always been under-funded?
3. What is the source of the problem of under-funding?
4. Who benefits from trauma research funding?
5. What are the most significant trauma and emergency care research objectives?
6. Where should funding start?
7. Does funding improve survival?
8. How much funding is needed for a coordinated injury prevention and trauma research effort?

1. Why does trauma and emergency care research need funding?

Traumatic injury is a major, largely unrecognized public health problem in the US. Trauma knows no bounds – trauma deaths cut across age, race, gender and economic boundaries.

Accounting for 37 million emergency department visits, in a single year, trauma kills three times the number of Americans killed during the entire Vietnam conflict.

While injury remains the leading cause of death in the population between the ages of 1 and 44, and one of the leading causes of death in those over 65, it is also sobering to note that more children die from trauma than from any other cause.

The resulting loss of productive life-years exceeds that of any other disease, with societal costs of $250 billion dollars annually (source: National Safety Council). The economic cost of 50 million injuries in the year 2000 alone will ultimately run upwards of $406 billion. This includes estimates of $80 billion in medical care costs, and $326 billion in productivity losses.

By the year 2020, injury will equal or surpass communicable diseases as the leader in worldwide disability-adjusted life-years lost.

Despite these alarming facts and the recognition that trauma care and trauma care systems can significantly improve survival and function, trauma still receives woefully inadequate funding for research.1

2. Has trauma and emergency care research always been under-funded?

Yes. Forty years ago the National Research Council report, Accidental Death and Disability, first focused attention on the inadequacy of emergency and trauma care research. Yet, the major research programs listed in the Congressionally Directed Medical Research Programs (CDMRP) include: breast cancer, prostate cancer, ovarian cancer, neurofibromatosis, tuberous sclerosis complex, chronic myelogenous leukemia, and prion diseases, none of which are directly related to trauma or emergency care.

In 1994, NIH convened a task force to study the trauma research needs and gaps and produced the Report of the Task Force on Trauma Research (NIH, 1994) This report recommended doubling funding to trauma research centers, but sufficient funding was never appropriated to carry this out.

Within the context of years of potential life lost (millions of dollars per years of potential life lost per 100,000 population), the NIH support ratio for HIV is $3.51, for cancer $1.65, and for trauma $.10. The total 1996 NIH budget allocation for traumatic injury and research was $194.4 million; however, allocations for the treatment and research of cancer were $2.57 billion for the same year.

Funding for the Peer Reviewed Medical Research Program (PRMRP) established in 1999 and managed by the CDMRP to promote "research directed toward specific health issues relevant to the military forces" totaled $294.5M in Congressional appropriations from 1999 to 2005. Trauma is the number one killer of our fighting soldiers. However, among 156 PRMRP grants awarded between 1999 and 2004, less than a third were related to trauma while the remainder went to cancer, chronic illnesses, and infectious diseases.

3. What is the source of the problem of under-funding?

The source of the problem is of course complex. Emergency and trauma research is a relatively young discipline and the fields that it encompasses are diverse. Not only are there gaps in emergency and trauma care research funding, but also in the training of new investigators.3

However, report after report has pointed toward the lack of a centralized organized infrastructure to guide the direction of study and the dispersal of funds.1-7

Deeply entrenched parochial interests have impeded progress, and today the field is as fragmented as ever. Accountability remains dispersed, and there is little public understanding of either the importance or the profound limitations of emergency and trauma care.

4. Who benefits from trauma research funding?

Injury from motor vehicle crashes (59%), falls (13%), assault (12%), burns (3%), and other accidents (12%) occurs every day and in every state of our nation. It does not discriminate between ages or social groups and the rates are not declining. The threat is magnified with the consideration of unexpected natural and man-made disasters. The inevitable terrorist activities in the U.S. will result in injuries not unlike those affecting our soldiers on the battlefields of the Middle East. In 2003, nearly 114 million visits were made to hospital emergency departments, more than 1 for every 3 people in the United States. About one-quarter of these visits were due to unintentional injuries. In addition to these hospital emergency department visits more than 32,000 soldiers have been injured in the current war. Many people are affected by trauma and many will benefit from trauma research funding.

5. What are the most significant trauma and emergency care research objectives?

Trauma and emergency care research has its foundation in basic laboratory science. But translational research-the process of applying ideas, insights, and discoveries generated through basic scientific inquiry to the treatment or prevention of human disease-is the most active area of this discipline. In 2005 "better translation of findings into patient care through guidelines" was at the top of the list of seven research priorities of the CDC updated Acute Care chapter of the 2002 agenda.

Trauma is a complex disease that involves direct mechanical injury to tissues as well as systemic disturbances of the entire organism. The field of inquiry involves many disciplines and crosscutting themes. Transport and admission to a trauma center of one trauma patient may involve paramedics, trauma and burn surgeons, trauma nurses, personnel from radiology, blood bank, respiratory therapy, rehabilitation and other ancillary disciplines, along with selected physicians from 16 specialties ranging from neurosurgery to OB/GYN. Unlike many other areas of medical research, it is not strictly defined by organ systems or types of conditions. Rather, it is uniquely defined by the urgency and location of treatment. Thus, the entire spectrum of trauma research begins in the acute setting at time of injury (prehospital EMS and hospital emergency department settings with significant extensions into prevention), proceeds to care of the patient in the hospital (ICU, OR and surgical departments), and on to rehabilitation. It is one of the most interdisciplinary fields in all of medicine, involving the collaboration of trauma surgeons, numerous medical specialties, engineers, behavioral scientists, and epidemiologists. Urgent subject areas of translational research include: injury prevention, triage, hemorrhage control, resuscitation, orthopedics, burn care, head injury, critical care, tissue engineering, rehabilitation and recovery, with categories devoted specifically to the extremes of age within each subject area.

To succeed, research must be based on the establishment of large-scaled multicenter research collaborations. Multicenter networks enable researchers from the diverse disciplines of trauma and emergency care research to assemble sufficiently large data sets to establish robust research findings. This means the quickest return of funding investments to the care of patients.

6. Where should funding start?

The National Research Council pointed out the inadequacy of emergency and trauma care research 40 years ago.

Traumatic injury has since surpassed heart disease as the most expensive category of medical treatment, resulting in $71.6 billion dollars in expenditures per year. We should not have to wait before the first projects are initiated.

Historically, trauma research was clinically focused on treatment of injury and was strongly influenced by advances in trauma treatment learned from battlefield experiences. Right now in Iraq and Afghanistan, medics, nurses and physicians are using new tourniquets, new wound dressings, new resuscitation techniques, better methods of damage control surgery, and innovative use of CT scans, that are saving lives of US military personnel and civilians injured in mass casualties. A consortium of civilian and Department of Defense centers is the natural starting point to translate these battlefield innovations to civilians at home. Such a consortium is also particularly qualified to conduct trauma research that is comprehensive, community-based and planned for all populations, incorporating the unique needs of children and the elderly. No one trauma center admits enough critically injured patients to support the type of randomized, controlled research projects needed to bring about steady, relatively rapid and substantial improvements. Thus, diverse multi-center trauma trials are required to provide sound unbiased scientific evidence to change clinical practice.

7. How does funding improve survival?

The extraordinary success of the federal HIV research program has resulted in a significant decline in the morbidity and mortality from this disease over the last 10 years.8

HIV funding ©

8. How much funding is needed for a coordinated injury prevention and trauma research effort?

Since 1981, the first year the epidemic was officially recognized, federal funding for HIV/AIDS research has increased significantly. From FY 1995 to FY 2004, federal HIV/AIDS research funding increased by 97%, from $1.5 billion to $3.0 billon.1 Funding for prevention ($638 million in FY 1995 to $933 million in FY 2004) heightened public awareness. Understanding AIDS (1988), a brochure prepared in consultation with U.S. Surgeon General C. Everett Koop was delivered to every residential mailing address in the United States.8 CDC programs increased basic knowledge about HIV transmission and prevention, reducing risky behavior within populations at risk for infection.

By the year 2020, injury will equal or surpass communicable diseases as the number 1 world-wide cause of disability-adjusted life years lost. A successful trauma research program should duplicate the AIDS awareness, funding, research, and prevention approach.1

References:

  1. Carrico CJ, Holcomb JB, Chaudry IH. Scientific priorities and strategic planning for resuscitation research and life saving therapy following traumatic injury: report of the PULSE Trauma Work Group. Acad Emerg Med. 2002;9(6):621-626.

  2. Committee on Trauma and Committee on Shock, Division of Medical Sciences. Accidental death and disability: the neglected disease of modern society. Washington, DC: National Academy of Sciences, National Research Council.; 1966.

  3. Committee on the Future of Emergency Care in the United States Health System, Board on Health Care Services. Hospital-Based Emergency Care: At the Breaking Point. Washington, D.C.: Institute of Medicine of the National Academies; 2006.

  4. Committee on Injury Prevention and Control, Institute of Medicine. Reducing the Burden of Injury: Advancing Prevention and Treatment. Washington, DC: National Academy Press; 1999.

  5. AHRQ. 2004. Funding Opportunities. [Online]. Available: http://www.ahrq.gov/fund/fudning.htm [accessed January 25, 2007]. In; 2004.

  6. Becker LB, Weisfeldt ML, Weil MH, Budinger T, Carrico J, Kern K, Nichol G, Shechter I, Traystman R, Webb C, Wiedemann H, Wise R, Sopko G. The PULSE initiative: scientific priorities and strategic planning for resuscitation research and life saving therapies. Circulation. 2002;105(21):2562-2570.

  7. Hoyt DB, Holcomb J, Abraham E, Atkins J, Sopko G. Working Group on Trauma Research Program summary report: National Heart Lung Blood Institute (NHLBI), National Institute of General Medical Sciences (NIGMS), and National Institute of Neurological Disorders and Stroke (NINDS) of the National Institutes of Health (NIH), and the Department of Defense (DOD). J Trauma. 2004;57(2):410-415.

  8. Evolution of HIV/AIDS Prevention Programs--United States, 1981-2006. CDC MMWR Weekly. June 2 2006;55 (21):597-603 http://www.cdc.gov/mmwR/preview/mmwrhtml/mm5521a5524.htm.

  9. Consolidated Appropriations Act, 2004 (PL 108-199). January 23 2004.

  10. Office of AIDS Research (NIH). National Institutes of Health Fiscal Year 2004 Plan for HIV-Related Research. Available at: http://www.nih.gov/od/oar/public/pubs/fy2004/i_overfiew.pdf.

  11. Johnson J, Colman S. AIDS Funding for Federal Government Programs: FY1981-FY2004. Washington, DC: Congressional Research Service; July 17 2003.

 

SAVE THE DATE!    14th ANNUAL SAN ANTONIO TRAUMA SYMPOSIUM: August 25-27, 2008