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MILITARY
MEDICINE
Leading
Advances in
Trauma Care
By Donald Jenkins, MD, FACS
Injury in motor vehicle crashes will take the lives of were designed to capture lessons learned from patient outcomes and
an estimated 3,500 people on Texas highways this year
alone. Contextually, that is more than the total number
of U.S. military deaths in wartime in Afghanistan over
the last 15-year period. Approximately 14,200 deaths due to injury
of all types are expected this year in Texas, with falls being one of
the most frequent causes.
Working closely with the partner organizations in 22 South Texas
counties, the Southwest Texas Regional Advisory Council (STRAC)
seeks to limit death and disability due to injury. Seventy-four hos-
pitals and over 70 EMS agencies collaborate to achieve this goal.
Featured prominently in the center of this life-saving care are the
adult and pediatric trauma centers at University Hospital, the
trauma center at San Antonio Military Medical Center, and the burn
center at the Institute of Surgical Research at Fort Sam Houston.
The trauma centers regularly exchange ideas and lessons learned
through interactions that STRAC facilitates. The Military Health
Institute at UT Health helps facilitate this work through a number
of mechanisms, many of which have research into life saving tech-
niques and procedures at their core.
The trauma surgery division at UT Health has a long history of
excellence in trauma care and trauma research. Every surgeon is cur-
rently engaged in more than one research project, has benefitted
from small research grants through MHI and some larger grants
through the Department of Defense. The largest current study, Re-
mote Trauma Outcomes Research Network (RemTORN), is a
DoD, UT Health, UH and STRAC collaboration studying out-
comes of people injured in South Texas. The next large DoD grant
will be used to study preventable deaths due to injury and will be a
national study run out of STRAC and UT Health. Both studies
16 San Antonio Medicine • August 2017
to develop new and better ways to treat injured patients.
Hemorrhage remains the number one factor associated with pre-
ventable death due to injury. Thus, another local collaborator is
South Texas Blood and Tissue Center, responsible for the procure-
ment and distribution of the majority of the blood donated and used
in South Texas. Together with the previously mentioned groups, a
plan is underway for the development of a new blood product line,
cold stored whole blood, which preserves the clotting function of a
unit of blood that is not retained once the donated blood is broken
down into its components. Long the gold standard in transfusion
(230,000 cold stored whole blood units transfused by the U.S. in
Vietnam), this highly potent product will be able to be carried by
the five helicopter EMS agencies for use in bleeding patients prior
to their arrival at the hospital. This is a necessity as the time and dis-
tance to definitive care across the 26,000 square miles of STRAC is
daunting; numerous patients die prior to or nearly immediately
upon arrival to definitive care.
The MHI at UT Health supports these research endeavors, holds
workshops to train investigators how to successfully apply for grant
funds to support research and facilitates the coordination of research
efforts among these various collaborators. To that end, at a single
scientific meeting, UT Health in conjunction with MHI, will pres-
ent six papers/posters at the Military Health System Research Sym-
posium this August in Florida.
San Antonio is uniquely positioned to learn about injury care best
practices both on the streets of the city and also from the battlefield
due to this unique collaboration, and to share those lessons bi-di-
rectionally so that U.S. troops and citizens of South Texas all benefit
from improvement in injury care.