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Project Information

Project Information


Military Trauma Care’s Learning Health System and its Translation to the Civilian Sector


Project Scope:

An ad hoc committee will define the components of a learning health system necessary to enable continued improvement in trauma care in both the civilian and the military sectors (improving survival and reducing morbidity). Trauma care, for the purposes of this report, is defined as encompassing: integrated and coordinating emergency medical services and trauma care systems; point of injury or tactical care; en-route care or care during transport; initial resuscitation including care at small facilities prior to trauma center; care at the trauma center including emergency medicine, trauma surgery and specialty surgical care, anesthesia, and critical care; and transition to but not inclusive of rehabilitation and recovery. In this endeavor, the committee will characterize the military’s Joint Trauma System (JTS) and Defense Health Program research investment and their integrated role as a continuous learning and evidence-based process improvement model. The committee will examine opportunities to ensure that the advances in trauma care developed by the Department of Defense (DoD) over the past decade from experiences in Afghanistan (Operation Enduring Freedom) and Iraq (Operation Iraqi Freedom) are sustained and built upon for future combat operations. Finally, the committee will consider the strategies necessary to more effectively translate, sustain and build upon elements of knowledge and practice from the military’s learning health system into the civilian health sector and lessons learned from the civilian sector into the military sector.

Specifically, the committee will address the following 3 tasks:

  1. Drawing from existing models, identify and describe the key components of a learning health system necessary to optimize care of individuals in military and civilian settings who have sustained traumatic injuries.
  2. Characterize the components of the military’s Joint Trauma System and the trauma research investment of the Defense Health Program that together have enabled real-time, evidence-based or evidence-guided process improvement in trauma care consistent with the principles of a learning health system. Consider how these components can or should be expanded and, where appropriate, standardized across DoD, and how they should align with other learning health systems, including those in the civilian sector such as regional or statewide trauma systems. In doing so:
    1. Characterize the relative uniqueness of the military’s Defense Health Program and its investment in trauma and injury research compared to other private or federal investments in trauma research. Discuss the benefits, limitations and relative effectiveness of its capabilities- and gaps-driven research approach.
    2. Characterize how civilian education systems for medical, allied health, and other relevant professions, as well as the military-specific medical education at the nation’s Uniformed Services University of the Health Sciences and across the Military Health System, prepare individuals to be leaders in this trauma-specific learning health system.
  3. Define how such a learning health system can ensure lessons learned from the military’s knowledge-generating research investment are sustained and built upon for future combat operations, and translated into the U.S. civilian health system. Consider the importance of relevant civilian and military trauma-related education and training systems, the need for military and civilian-sector trauma-focused research investment, systematic processes for changing system-wide protocols, and/or performance improvement processes for providers.
    1. Identify mechanisms to enable implementation of knowledge, interventions and/or trauma care processes from the military into practice by the civilian sector (civilian trauma systems, trauma centers, and relevant emergency medical services including first responders), and vice versa.
    2. Identify factors that promote or limit that translation, considering ethical considerations in defining evidence standards necessary for changes in clinical care or guidelines and the value of a “focused empiricism” approach.

To address the above tasks, the committee will draw upon 3-4 case studies centered around common combat-related injuries that are also relevant to civilian sector trauma cases and highlight the opportunities and challenges to establishing and sustaining a trauma care learning health system. The case studies may be based upon the following traumatic injuries, or other relevant examples, and should feature real life medical cases. One case study should include pediatric trauma care. 

  • Complex dismounted secondary blast injury with extremity amputation, face injuries, a compromised airway and hemorrhagic shock
  • Secondary blast injury with penetrating fragment wounds to the head and extremities with an extremity vascular injury and shock
  • 35% total body surface area burn with early renal and pulmonary failure
  • Explosive injury resulting in tension pneumothorax, blunt solid organ injury with intra-peritoneal hemorrhage and shock
  • High velocity gunshot wound to the thigh with soft tissue injury, open femur fracture, vascular injury and limb ischemia
  • Closed complex pelvic and femur fractures with hemorrhagic shock

The case studies will highlight to the extent possible:

  • Levels of evidence used to develop military and civilian (as applicable) clinical guidelines for the spectrum of trauma care in each case
  • Pertinent innovative changes (devices, medications, equipment, methods) that have been incorporated into the spectrum of trauma care for each case as a result of the DoD’s evidence-based improvement process.
  • Processes by which patient and injury information was collected, stored, reviewed and analyzed by the JTS; including how this information was used for the JTS’s evidence-based improvement process and made available for clinical and epidemiologic research
  • How collection, storage, review and analysis of patient injury and management information differed for those killed in action versus those wounded in action (i.e., different system for those who die prior to arrival at a medical center thus eliminating ability to study ways to improve survival).
  • Impact that evidence-supported changes in military trauma care and the JTS’s evidence-supported process improvement may have had on survivability.
  • How the results of the military’s DHP research investment and elements of focused empiricism have been integrated into the JTS, its Clinical Practice Guidelines and usual military practice
  • Evidence of how these changes may be effectively integrated into military training and doctrine (e.g. special units such as the Army Rangers) and how these lessons learned can be applied in the civilian sector.
  • Time elapsed between the compilation/publication of evidence and development and implementation of clinical guidelines.

 

Status: Current

PIN: IOM-HSP-14-08

Project Duration (months): 21 month(s)

RSO: Downey, Autumn

Topic(s):

Conflict and Security Issues
Health and Medicine
Math, Chemistry, and Physics



Geographic Focus:

Committee Membership

Committee Post Date: 09/22/2015

Donald M. Berwick - (Chair)
Institute for Healthcare Improvement

Donald M. Berwick, M.D., M.P.P., FRCP, President Emeritus and Senior Fellow, Institute for Healthcare Improvement, is also former Administrator of the Centers for Medicare & Medicaid Services. A pediatrician by background, Dr. Berwick has served on the faculty of the Harvard Medical School and Harvard School of Public Health, and on the staffs of Boston's Children's Hospital Medical Center, Massachusetts General Hospital, and the Brigham and Women's Hospital. He has also served as Vice Chair of the US Preventive Services Task Force, the first "Independent Member" of the American Hospital Association Board of Trustees, and Chair of the National Advisory Council of the Agency for Healthcare Research and Quality. He served two terms on the Institute of Medicine's (IOM's) Governing Council, was a member of the IOM's Global Health Board, and served on President Clinton's Advisory Commission on Consumer Protection and Quality in the Healthcare Industry. Recognized as a leading authority on health care quality and improvement, Dr. Berwick has received numerous awards for his contributions. In 2005, he was appointed "Honorary Knight Commander of the British Empire" by the Queen of England in recognition of his work with the British National Health Service. Dr. Berwick is the author or co-author of over 160 scientific articles and six books.
Ellen P. Embrey
Stratitia, Inc.

Ellen Embrey, is Managing Partner of Stratitia, Inc., and 2c4 Technologies, Inc.. Stratitia is
a strategy and management consulting firm specializing in supporting clients that serve the healthcare, national security, and information technology sectors , and 2c4 Technologies specializes in providing health sector IT solutions and services. She also is a counselor in The Cohen Group, a firm that provides global business consulting services and advice on tactical and strategic opportunities in virtually every market. Ms. Embrey has extensive executive and program leadership experience in the executive branch of the federal government. In her last federal role, she served as the Assistant Secretary of Defense (Health Affairs) and the Director, TRICARE Management Activity during the presidential transition period in 2009-2010. In that capacity, she led and managed the Military Health System, a $47 billion/year defense health program employing more than 200,000 health professionals serving more than 9.6 million service members, retirees and their families in more than 70 hospitals and 500 clinics and laboratories around the globe. As Deputy Assistant Secretary of Defense (Force Health Protection and Readiness) for eight years, Ms. Embrey orchestrated significant improvements in Department of Defense policies and programs from 2002-2009, affecting deployment and combat casualty medicine, health promotion and preventive medicine, medical readiness and public health emergency preparedness and response. As DoD’s “line of action” lead for addressing traumatic brain injuries and/or post traumatic stress disorder, she led collaborative efforts to identify gaps and prioritize investments in TBI & PTSD research, align clinical best practices of DoD and VA, and establish new US ICD9 codes for traumatic brain injury diagnoses and treatment based on DoD/VA experience. At the Secretary of Defense’s request, Ms. Embrey led a landmark study of Sexual Assault in the Military, making recommendations that led to widespread reforms in this area across the Department. Throughout 2001, during the presidential transition period, Ms. Embrey served as the Assistant Secretary of Defense for Reserve Affairs, shaping policies affecting the readiness and use of the National Guard and Reserve in both federal and state status. From 2000 to 2001, she served as Chief of Staff of that office, and from 1998 to 2001, as Deputy Assistant Secretary of Defense for Military Assistance to Civil Authorities, developing policies that shaped the role of the National Guard and Reserve components in supporting homeland security, disaster preparedness, and national disaster response capabilities, including advising the president on such matters in the days and weeks following September 11, 2001. Over her distinguished 35 year federal career, Ms. Embrey received many awards, the highest of which include two Secretary of Defense Distinguished Civilian Service Awards, in 2001 and 2004, and two Presidential Meritorious Executive Rank Awards, in 2006 and 2009.
Sara Goldkind
Independent Consultant

Sara Goldkind, M.D., M.A. is currently an independent Research and Clinical Bioethics Consultant. She was formerly the Senior Bioethicist at The Food and Drug Administration in the Office of Good Clinical Practice located within the Office of the Commissioner. In this position, she served as an Agency expert for medical ethics and participates in the planning, management, and implementation of bioethics activities and policies across FDA. These activities include ethics consultation, guidance and policy development, educational programming, and evaluation of the ethical aspects of research involving human subjects, including clinical trial oversight. Dr. Goldkind came to FDA in 2003. Prior to coming to FDA, she was involved in clinical consultative ethics, policy development and education both in the clinical setting as well as academia. She is a board certified internist. Dr. Goldkind completed a fellowship in clinical medical ethics at the University of South Florida-School of Medicine, where she was on the faculty within the Department of Medicine and obtained a Master’s Degree in religious studies focusing on comparative religious ethics and public policy.
Adil Haider
Brigham and Women's Hospital

Adil Haider, M.D., M.P.H. is a clinically active trauma surgeon, widely- published researcher and the Kessler Director for the Center for Surgery and Public Health, a joint initiative of Brigham and Women’s Hospital, Harvard Medical School and Harvard TH Chan School of Public Health. Prior to accepting this position, he was Director of the Center for Surgery Trials and Outcomes Research and Associate Professor of Surgery, Anesthesiology and Critical Care Medicine at the Johns Hopkins School of Medicine. His research focuses on long term clinical and functional outcomes after trauma, race and gender disparities in health care, optimal treatment of trauma/critically ill patients in resource poor settings, and advanced analytics for outcomes research using large databases. Dr. Haider recently led a team of researchers that conducted a nationwide study on the impact of contemporary military practices on civilian trauma care that identified successes and barriers in translating the military’s experience to the civilian setting.

John B. Holcomb
University of Texas

COL (ret) John Bradley Holcomb, M.D., F.A.C.S., has been a leader in trauma surgery and related research at the University of Texas Health Science Center in Houston since his 2008 retirement from the Army. He serves as director of the Center for Translational Injury Research, chief of the Division of Acute Care Surgery, professor and vice chair of the Department of Surgery, and as the Jack H. Mayfield, M.D., Chair in Surgery. In 1993 Holcomb was deployed with Special Operations to Somalia, where he cared for soldiers who were severely wounded on the battlefield of Mogadishu in the violent Black Hawk Down episode. The experience had a profound impact, spurring his decision to dedicate his career to trauma surgery and research aimed at improving outcomes for the injured. In 1997 Holcomb became chief of the Military Trauma Research Branch of the U.S. Army Institute of Surgical Research (USAIR). In 2001, he completed a surgical critical care fellowship at the University of Texas at Houston while serving as the trauma advisor to the U.S. Special Operations Command. From 2002 until his retirement from the military in 2008, he served as both commander of USAIR and trauma consultant to the Army Surgeon General. Because of Holcomb’s leadership, the military began issuing life-saving tourniquets to every member of the U.S. Armed Forces deployed in combat zones. He initiated the use of hemostatic dressings in place of gauze dressings to stem bleeding more effectively, introduced major advances in resuscitation, and greatly improved how the military transports wounded service personnel to the most appropriate field hospital. Holcomb’s achievements and dedication to service men and women earned him numerous military honors including the Honorary Medal for Combat Surgical Care, the Army’s Development Achievement Award for Leadership and Excellence and the U.S. Special Forces Command Medal. In 2008, the American Heart Association presented Holcomb with its Lifetime Achievement Award in Trauma Resuscitation Science.
Brent C. James
Intermountain Healthcare

Brent C. James, MD, MStat is the Chief Quality Officer and Executive Director, Institute for Health Care Delivery Research at Intermountain Healthcare. Intermountain is an integrated system of 23 hospitals, almost 150 clinics, a 700+ member physician group, and an HMO/PPO insurance plan jointly responsible for more than 500,000 covered lives serving patients in Utah, Idaho, and, at a tertiary level, seven surrounding States. Brent James is known internationally for his work in clinical quality improvement, patient safety, and the infrastructure that underlies successful improvement efforts, such as culture change, data systems, payment methods, and management roles. He is a member of the National Academy of Science’s Institute of Medicine (and participated in many of that organization’s seminal works on quality and patient safety). Dr. James was recently recognized for his pioneering work in applying quality improvement techniques that were originally developed by W. Edwards Deming and others and awarded the 2011 Deming Cup. The award is given annually to an individual who has made outstanding contributions in the area of operations and has established a culture of continuous improvement within his or her respective organization. Dr. James was instrumental in helping create and implement a “system” model at Intermountain, in which physicians study process and outcomes data to determine the types of care that are most effective. He holds faculty appointments at the University of Utah School of Medicine (Family Medicine and Biomedical Informatics), Harvard School of Public Health (Health Policy and Management), and the University of Sydney, Australia, School of Public Health. Through the Intermountain Advanced Training Program in Clinical Practice Improve-ment (ATP), he has trained more than 3500 senior physician, nursing, and administra-tive executives, drawn from around the world, in clinical management methods, with proven improvement results (and more than 30 “daughter” training programs in 6 countries) Before coming to Intermountain, he was an Assistant Professor in the Department of Biostatistics at the Harvard School of Public Health, providing statistical support for the Eastern Cooperative Oncology Group (ECOG); and staffed the American College of Surgeons’ Commission on Cancer. He holds Bachelor of Science degrees in Computer Science (Electrical Engineering) and Medical Biology; an M.D. degree (with residency training in general surgery and oncology); and a Master of Statistics degree. Dr. James serves on several non-profit boards of trustees, dedicated to clinical improvement.
Jorie Klein
Parkland Health & Hospital System

Jorie Klein is the Director of the Trauma Program, Disaster Management, and North Texas Poison Center for Parkland Health & Hospital System in Dallas, Texas. She has a long history of exemplary trauma leadership at the state, regional, and national levels including: President of the Texas EMS, Trauma, and Acute Care Foundation; Vice-Chair of the Governor's Emergency/Trauma Advisory Council's Trauma System (Texas); Chair of the Texas Hospital Association's Policy Committee on Trauma and Emergency Services; and Chair of the Texas Hospital Association's Trauma Technical Advisory Group. Ms. Klein is a past president of the Society of Trauma Nurses (STN) and has also served on numerous STN committees, from the Annual STN Conference Committee (which she chaired from 1998 - 2004) to ATCN Regional Chair and State Chair for Texas. She has received many awards for her service to the trauma community, most recently Governor's EMS/Trauma Council's Journey of Excellence Award (2009). Ms. Klein has authored papers, book chapters, and courses on emergency preparedness, disaster management, mechanism of injury, decision-making in trauma care, and preparing for a trauma site visit, among others. She has been a frequent invited speaker on a vast array of trauma topics for both national and international audiences.
Douglas Kupas
Temple University School of Medicine

Douglas Kupas, M.D., serves as the Associate Chief Academic Officer for Simulation and Medical Education for Geisinger Health System where he also practices as an emergency physician. He is board certified in Emergency Medicine and the subspecialty of Emergency Medical Services. Dr. Kupas is also the Assistant Dean for Student Affairs at the Geisinger campus for Temple University School of Medicine. Dr. Kupas completed his Emergency Medicine Residency Program at Geisinger Medical Center, Danville, PA. His graduate degree was completed at Jefferson Medical College of Thomas Jefferson University and his undergraduate degree at Indiana University of Pennsylvania. He is a member of numerous local, state and national organizations. He has numerous honors, awards and publications to his credit. He remains active in his field of research. Doug is a paramedic and has been an active field EMS provider since 1980. Dr. Kupas also serves as the Commonwealth EMS Director for the Bureau of Emergency Medical Services for the Pennsylvania Department of Health. He is the former Chair of the Medical Directors Council of the National Association of EMS Officials, the Mobile Integrated Healthcare/ Community Paramedicine Committee of the National Association of EMS Physicians (NAEMSP), the Standards and Practices Committee of NAEMSP, and the Rural EMS Committee of NAEMSP. His clinical and research interests include EMS medical direction, EMS provider and patient safety, field trauma triage, emergency airway management, therapeutic hypothermia, wilderness EMS, and simulation in medical education. Dr. Kupas directs the ARCTIC (Advanced Resuscitation Cooling Therapies in Cardiac Arrest) program at Geisinger Health System, and he partnered with the HeartRescue project to advance statewide out-of-hospital cardiac arrest care in Pennsylvania. Additionally, Dr. Kupas was involved in writing a national position statement on patient restraint that guided the development of protocols for EMS operations across the country. He also participated in evidence-based reviews for the International Liaison Committee on Resuscitation that drafts the guidelines used by the American Heart Association and other resuscitation groups around the world and for the Centers for Disease Control/American College of Surgeons field trauma triage guidelines. He has served as the state EMS medical director for Pennsylvania since 2000, and during that time he led the process developing statewide EMS protocols. He participated in projects to develop implement national evidence-based guidelines for EMS.
Cato T. Laurencin
University of Connecticut Health Center

Cato T. Laurencin, M.D., Ph.D., is the Albert and Wilda Van Dusen Distinguished Professor of Orthopaedic Surgery, Professor of Chemical and Biomolecular Engineering, Professor of Materials Science and Engineering, and Professor of Biomedical Engineering at the University of Connecticut. Dr. Laurencin is the founder and director of both the Institute for Regenerative Engineering and the Raymond and Beverly Sackler Center for Biomedical, Biological, Physical and Engineering Sciences at the University of Connecticut. He also serves as Chief Executive Officer of the Connecticut Institute for Clinical and Translational Science at UCONN. For his outstanding achievements in medicine, engineering and science, and for his distinguished service to the university, UCONN named him a University Professor. He is the 8th in UCONN’s 130 year history. Dr. Laurencin earned his B.S.E. in chemical engineering from Princeton University and his M.D., Magna Cum Laude, from the Harvard Medical School. He simultaneously earned his Ph.D. in biochemical engineering/biotechnology from the Massachusetts Institute of Technology where he was a Hugh Hampton Young Fellow. Dr. Laurencin’s work in science focuses on biomaterials, nanotechnology, drug delivery, stem cell science and a new field he has pioneered, Regenerative Engineering. In 2012, his work was highlighted by National Geographic Magazine in its edition, “100 Scientific Discoveries that Changed the World”. Dr. Laurencin’s work is funded by the National Science Foundation, the Department of Defense, and the National Institutes of Health, where he is a recipient of a 2014 NIH Pioneer Award for his work in Regenerative Engineering. A practicing shoulder and knee surgeon, Dr. Laurencin is a Fellow of the American College of Surgeons, a Fellow of the American Surgical Association, and a Fellow of the American Academy of Orthopaedic Surgeons. He won the Nicolas Andry Award from the Association of Bone and Joint Surgeons. He has been listed in America’s Top DoctorsTM continuously for the past decade. A Fellow of the American Chemical Society, the American Institute of Chemical Engineers, the Materials Research Society and the American Association for the Advancement of Science, Dr. Laurencin is a Fellow of the American Institute for Medical and Biological Engineering and served as the Chair of the College of Fellows. He is an International Fellow in Biomaterials Science and Engineering and served on the Council of the Society for Biomaterials. He is a Fellow of the Biomedical Engineering Society and has been a member of the Board of Directors. Dr. Laurencin received the Presidential Faculty Fellowship Award from Bill Clinton in recognition of his research work bridging medicine and engineering. In 2009, the American Institute of Chemical Engineers named him one of the 100 Engineers of the Modern Era at its centennial celebration. In 2014, he received the Percy Julian Medal from the National Organization of Black Chemists and Chemical Engineers at its annual meeting. Dr. Laurencin has been active in service to our nation. He has served on the National Science Advisory Board of the U.S. Food and Drug Administration (FDA), the National Science Foundation’s Engineering Advisory Committee (ADCOM), the National Institutes of Health Advisory Council for Biomedical Imaging and Bioengineering and the National Institutes of Health Advisory Council for Arthritis, Musculoskeletal and Skin Diseases. At the National Academies he has served as Co-Chair of the Clinical Effectiveness Research Innovation Collaborative as a member of the Institute of Medicine Roundtable on Value and Science Driven Health Care. Dr. Laurencin is an outstanding mentor. He has received the Presidential Award for Excellence in Science, Mathematics and Engineering Mentoring from President Barack Obama in ceremonies at the White House, the Elizabeth Hurlock Beckman Award for Mentoring, the Alvin H. Crawford Mentoring Award from the J. Robert Gladden Orthopaedic Society, and the American Association for the Advancement of Science’s Mentor Award. Dr. Laurencin is an elected member of the Institute of Medicine of the National Academy of Sciences, and an elected member of the National Academy of Engineering. Internationally, he is an elected Fellow of the African Academy of Sciences and an elected Fellow of the World Academy of Sciences.
Ellen J. MacKenzie
Johns Hopkins University School of Hygiene and Public Health

Ellen MacKenzie, Ph.D., is the Fred and Julie Soper Professor and Chair of the Department of Health Policy and Management at the Johns Hopkins Bloomberg School of Public Health and Director of the Major Extremity Trauma Research Consortium, dedicated to advancing limb trauma care and outcomes through research.
She is a graduate of the School of Public Health where she earned Master of Science and doctoral degrees in biostatistics. She joined the Hopkins faculty in 1980 and holds joint appointments in the School's Department of Biostatistics and with the departments of Emergency Medicine and Physical Medicine and Rehabilitation at the Johns Hopkins University School of Medicine. In addition to her faculty appointments, Dr. MacKenzie served as Senior Associate Dean at the School from 1996 to 2000 and Director of the Center for Injury Research and Policy from 1995-2005. Dr. MacKenzie completed a term as chair of the National Advisory Committee for Injury Prevention and Control and was past President of the American Trauma Society. Dr. MacKenzie's research focuses on the impact of health services and policies on the short- and long-term consequences of traumatic injury, with a special emphasis on orthopaedic trauma outcomes research. She has contributed to the development and evaluation of tools for measuring both the severity and outcome of injury and her research has advanced our understanding of both the clinical and non-clinical factors that influence recovery post-injury. Dr. MacKenzie was Co-PI on the LEAP study and the METALS study. She was also PI on the National Study on the Costs and Outcomes of Trauma Care (NSCOT). Some of her more recent efforts include the development and evaluation of self management programs for survivors of serious trauma. Her awards include the A.J. Mirkin Service Award from the Association for the Advancement of Automotive Medicine, the Kappa Delta Award from the American Academy of Orthopaedic Surgeons (for the LEAP Study), Distinguished Career Awards from the American Public Health Association and the American Trauma Society, and the Trauma Leadership Award from the Society of Trauma Nurses. She is also an honorary fellow of the American Association for the Surgery of Trauma and in 2012 was named by CDC as one of 20 leaders and visionaries who have had a transformative effect on the field of violence and injury prevention over the past 20 years.
David E. Marcozzi
Centers for Medicare and Medicaid Services

David Marcozzi, M.D., MHS-CL, FACEP, is Senior Advisor for Emergency Preparedness and Acute Care within the Centers for Medicare and Medicaid Services (CMS) at the Department of Health and Human Services (HHS). Before moving to CMS, he was the Director of the National Healthcare Preparedness Program (NHPP), within the Office of the Assistant Secretary of Preparedness and Response at the U.S. Department of Health and Human Services. In September 2011, Dr. Marcozzi returned to HHS after completing a 3-year detail at the White House National Security Council as Director of All-Hazards Medical Preparedness Policy. While there, he led multiple Sub-Interagency Policy Committees and assisted with responding to several events including the 2010 Haiti earthquake. Prior to his federal positions, Dr. Marcozzi was an Assistant Professor of Emergency Medicine at Duke University Medical Center and completed a congressional fellowship at the U.S. Senate. Serving on the Bioterrorism and Public Health Preparedness Subcommittee, he assisted in drafting the Pandemic and All-Hazards Preparedness Act that became law in 2006. Dr. Marcozzi continues to practice emergency medicine and is a Fellow of the American College of Emergency Physicians. Currently, he is an Associate Clinical Professor of
Emergency Medicine at George Washington University. A Lieutenant Colonel in the U.S. Army Reserves, Dr. Marcozzi has been mobilized four times since 2001 and is now assigned to the U.S. Army Special Operations Command as a Deputy Surgeon. As a prior member of the National Disaster Medical System, Dr. Marcozzi responded to multiple disasters including the September 11, 2001 attack on the World Trade Center. The author of several articles and scientific manuscripts, he is also the recipient of numerous military and civilian awards including the National Security Council Outstanding Achievement Award, a Certificate of Appreciation from the Assistant to the President for Homeland Security and Counterterrorism, the Army Commendation Medal, the National Disaster Medical System Distinguished Member Award and the Duke Emergency Medicine Distinguished Faculty Award.
Joe McCannon
Bill and Melinda Gates Foundation

Before co-founding the Billions Institute, Joe McCannon was an appointee in the Obama Administration, serving as Senior Advisor to the Administrator at the Centers for Medicare and Medicaid Services (CMS) in the U.S. Department of Health and Human Services (HHS). There he rolled out major pieces of the Affordable Care Act and was part of the founding leadership team at the Center for Medicare and Medicaid Innovation (CMMI), directing its Learning and Diffusion Group. Before this, he was Vice President and faculty on large-scale improvement at the Institute for Healthcare Improvement (IHI), leading the organization’s major domestic initiative to improve patient safety, the 100,000 Lives Campaign, and starting its work in Africa. He has supported large-scale transformation in several nations, including Canada, Denmark, England, Japan and South Africa, and consulted on the topic for a number of organizations, including the Bill and Melinda Gates Foundation, the World Health Organization and Community Solutions (100,000 Homes Campaign). He started his career in the publishing industry with roles at Fast Company, The Atlantic Monthly, and Outside magazine. He is a graduate of Harvard University and was a Reuters Fellow at Stanford University.
John A. Parrish
Massachusetts General Hospital

John A. Parrish, M.D., is the Chief Executive Officer and founder of the Consortia for Improving Medicine with Innovation and Technology (CIMIT), a consortium of academic and engineering research laboratories, universities and more than 40 private-sector companies. Through CIMIT, clinical investigators work to advance the standards of care for all patients through the development and the adoption of targeted medical devices and technologies. Trained in internal medicine, dermatology and clinical research, Dr. Parrish has been recognized as a visionary and innovator who lists among his accomplishments the development of therapies to treat skin disease, including the now-common use of ultraviolet light. For two decades, Dr. Parrish served as chief of the Department of Dermatology at Massachusetts General Hospital, founding the Wellman Center for Photomedicine, the first – and now the world’s largest – multidisciplinary research group to study the effects of lasers on tissue. A graduate of Duke University and Yale University School of Medicine, Dr. Parrish is the author or co-author of more than 300 publications, including six books. Dr. Parrish has earned the Discovery Award from the National Dermatology Foundation; the Bowditch Prize from Massachusetts General Hospital for enhancing the quality of patient care while reducing the cost of that care; the U.S. Army’s Thurman Award, honoring the late Gen. Maxwell Reid Thurman, who championed the advancement of lifesaving medical technologies within the U.S. Army; and the 2011 Humanitarian Award, for his wide-ranging lifetime professional contributions to the field of dermatology. Dr. Parrish proudly served in the United States Marine Corps and was a battlefield doctor in Vietnam. As a result, he is acutely aware of the needs of soldiers and their supportive medical units. He is the Founding Director of the Boston Red Sox Foundation-Massachusetts General Hospital Home Base Program, a novel public/private partnership aimed at helping veterans of the wars in Afghanistan and Iraq who are affected by post-traumatic stress disorder and traumatic brain injury.
Rita Redberg
University of California, San Francisco

Rita Redberg, M.D., F.A.C.C., M.Sc.
Professor of Medicine
University of California, San Francisco

Rita F. Redberg has been a cardiologist and Professor of Medicine at the University of California, San Francisco since 1990. She is currently the Chief Editor of JAMA Internal Medicine (formerly Archives of Internal Medicine). Dr. Redberg’s research interests are in the area of health policy and technology assessment; her work includes comparative effectiveness research and focuses on how evidence relates to FDA approval, insurance coverage and medical guidelines and practice. Dr. Redberg is a member of the Medicare Payment Advisory Commission that advises Congress on Medicare payment policy. She has chaired the Medicare Evidence, Development and Coverage Advisory Commission since 2012 and also served as a member from 2003 to 2006. Dr. Redberg was recently appointed to the Clinical Advisory Panel for the California CABG Outcomes Reporting Program where she joins several other IHPS faculty. She currently is a member of the California Technology Assessment Forum, the Medical Policy Technology and Advisory Committee, and the Food and Drug Administration Cardiovascular Devices Expert Panel and is a consultant to the Center for Medical Technology Policy. She and Sanket Dhruva recently completed an extensive review of the FDA Cardiovascular Device pre-market approval (PMA) process including issues related to gender bias and has ongoing work looking at post market surveillance of medical devices, including collaborations with the Pew Charitable Trusts and the FDA. In addition, Dr. Redberg is a member of the American College of Cardiology’s (ACC) Clinical Quality Committee, serves on the ACC Quality in Technology Work Group, is a member of the ACC Comparative Effectiveness Work Group, represents the ACC on the Institute of Clinical and Economic Review Advisory Board, and serves on other ACC Committees, including several on appropriate use of cardiac imaging and radiation safety. She was a member of the Institute of Medicine’s Learning Health Care Committee, and she has chaired the AHA/ACC Writing Group on Primary Prevention Performance Measures. Dr. Redberg graduated from Cornell University and the University of Pennsylvania Medical School and has a Masters of Science in Health Policy and Administration from the London School of Economics. She earned her medical degree from the University of Pennsylvania School of Medicine, in Philadelphia. In addition, Dr. Redberg has a masters of science in health policy and administration from the London School of Economics in England.
James Robinson
Denver Health and Hospital Authority

James Robinson currently serves as the Chief of Special Operations for Denver Health EMS. He is the current President and a founding member of the International Association of EMS Chiefs. Chief Robinson began his EMS career as a volunteer EMT in 1989, and went on to a professional career with the City and County of Denver in 1993 as a field paramedic. Since then, he has been involved in every facet of the Denver Health Paramedic Division’s operations, and has been an Assistant Chief since 2005. In addition to his Denver Health role, Chief Robinson serves as the chairman of the Denver UASI/Colorado North Central All-Hazards Region's EMS subcommittee, as an EMS representative to the State of Colorado All-Hazards Advisory Committee, as a member of the State of Colorado's ESF-8 Steering Committee and as the past Denver Metro Region 3 Board of Directors' representative to the Emergency Medical Services Association of Colorado. He has been involved in numerous local and State of Colorado committees and boards on EMS, public health and emergency management. Chief Robinson has been involved in numerous national-level EMS initiatives as well, including the National EMS Preparedness Initiative summits through George Washington University, the Systems Subcommittee of the National EMS Advisory Council, the Department of Homeland Security Interagency Board Active Shooter Working Group and others. Chief Robinson holds a BS, Magna Cum Laude, in Human Services from Metropolitan State University of Denver and is a graduate of Cohort 6 of the Harvard Kennedy School of Government and the Harvard School of Public Health’s National Preparedness Leadership Initiative (NPLI). He is currently a master’s degree candidate in the Naval Postgraduate School's Center for Homeland Defense and Security Master's Degree Program.
Thomas M. Scalea
University of Maryland, College Park

Thomas M. Scalea, M.D. was born in Rochester, New York. He attended the University of Virginia and then the Medical College of Virginia. Dr. Scalea did his residency at the Upstate Medical Center in Syracuse, New York, and his Trauma Critical Care Fellowship at New York Medical College. Following his fellowship, Dr. Scalea began his career at the Kings County Hospital/Downstate Medical Center. He became Chief of Trauma and Critical Care and rose to the rank of Professor. He also founded the Department of Emergency Medicine at Downstate. In 1997, Dr. Scalea became the Physician-in-Chief at the R Adams Cowley Shock Trauma Center at the University of Maryland, the nation’s only freestanding trauma hospital. Several years later, he became the first medical school endowed Professor of Trauma, when he was appointed the Honorable Senator Francis X. Kelly Distinguished Professor in Trauma Surgery. Dr. Scalea is also the System Chief for Critical Care Services at the University of Maryland Medical System. Under Dr. Scalea’s leadership, his program has expanded clinical services remarkably. His faculty is now responsible for all of the acute care and emergency general surgery patients at the University of Maryland Medical Center. The group has built a region wide critical care program and is now responsible for 9 Intensive Care Units and approximately 140 beds. Under his leadership, the trauma volumes have grown 40% over the last 15 years.
Dr. Scalea has greatly expanded the research portfolio; joining with the Department of Anesthesiology he created the Shock Trauma and Anesthesiology Research Center. This is one of a very few organized research centers at the University of Maryland School of Medicine. Recruiting a new Director, DOD and NIH funded research has increased from approximately $3 million to over $13 million over the past few years. The Shock Trauma group routinely participates in all of the major multi-institutional trials done in trauma in the United States. The educational program has also expanded considerably. Shock Trauma houses the largest ACGME Surgical Critical Care training program in the country, as well as the largest AAST approved Acute Care Surgery Fellowships. Shock Trauma is one of the few places to have an ACGME approved Surgical Critical Care Fellowship for emergency physicians, allowing them to take the Surgical Critical Care Board Exam. In 2001, Dr. Scalea established the US Air Force C-STARS Program (Center for Sustainment of Trauma and Readiness Skills). This program trains Air Force men and women of all disciplines, refining trauma skills before deployment. For the last 14 years, C-STARS has trained approximately 4,000 people before deployment in either Iraq or Afghanistan. In 2008 and 2011, Dr. Scalea traveled to Iraq and Afghanistan respectively to observe the Wounded Warrior Care System in the field, during the critical care air transport and in military hospitals to provide unbiased recommendations on how to improve the system, as well as to determine how to continually refine trauma training. Dr. Scalea also served as a Senior Visiting Surgeon at Landstuhl Regional Medical Center, providing care for injured soldiers as they were evacuated from Iraq.
C. W. Schwab
University of Pennsylvania Medical Center

C. William Schwab, M.D., F.A.C.S., F.R.C.S., is currently Professor of Surgery at the University of Pennsylvania. In 1987, Dr. Schwab established a Level I Regional Resource Trauma Center, Surgical Critical Care Service, the PennSTAR Flight Program and the Communications Center at the University of Pennsylvania Medical Center. Today, Dr. Schwab’s surgical practice focuses on caring for the severely injured patient and developing regional trauma and emergency care systems. He is one of the first traumatologists to study the effects of trauma in the elderly patient. In addition, Dr. Schwab is active in the field of violence prevention and continues to teach trauma surgeons how to become leaders in the public health effort to reduce firearm-related injuries. He directs the University of Pennsylvania Trauma Network. This involves administrating and coordinating several centers throughout Eastern Pennsylvania with Penn’s Level I trauma center to enhance the quality of trauma and emergency care. Lastly, he directs the fellowship program in trauma surgery and critical care at the Hospital of the University of Pennsylvania, a program with ten trainees annually and over 70 graduates located throughout the world. Dr. Schwab received his medical degree from the State University of New York. During medical school he joined the U.S. Navy and did his residency during the Vietnam war at the Naval Regional Medical Center in Portsmouth, VA.
Phillip Spinellla
Washington University School of Medicine

Philip C. Spinella, M.D., FCCM is an Associate Professor, and the Director of the Critical Care Translational Research, at Washington University School of Medicine. He has published approximately 100 manuscripts/chapters, and has been an invited speaker at over 100 institutions globally on the topic of traumatic hemorrhagic shock. As a well-established investigator, having been awarded ~$20 million from the DoD and NIH, he is primary investigator of two randomized controlled trials: ABC-PICU, examining effects of red blood cell storage age on outcomes in critically ill children; and TAMPITI, examining immunologic effects of TXA in adults with severe traumatic injuries. He served 15 years in the US Army, separating as LTC. As a veteran of the Iraq War, he received a Bronze Star, Combat Medic Badge and the US Army's Best Invention Award for the concept of “Damage Control Resuscitation”. Dr. Spinella has previously served as consultant to the US Army Blood Research Program at the US Army Institute of Surgical Research, Homeland Security, the Public Health Service - Northeast Region, and the Norwegian Navy Blood Research Program. He is co-founder and Chair of the Pediatric Critical Care Blood Research Network, and the Trauma Hemostasis and Oxygenation Research Network. Both are international multidisciplinary networks that aim to improve outcomes for patients with shock or coagulopathy.

Committee Membership Roster Comments

Note (07-06-2015): There has been a change in the committee membership with the appointment of Dr. Brent James.
Note (09-18-2015): There has been a change in the committee membership with the loss of Dr. Norman McSwain and the resignation of Dr. Uwe Reinhardt.
Note (09-22-2015): There has been a change in the committee membership wiht the appointment of Mr. James Robinson.

Events



Location:

Teleconference
Event Type :  
-

Registration for Online Attendance :   
NA

Registration for in Person Attendance :   
NA


If you would like to attend the sessions of this event that are open to the public or need more information please contact

Contact Name:  Autumn Downey
Contact Email:  adowney@nas.edu
Contact Phone:  202-334-2046

Agenda
This meeting was closed in its entirety.
Supporting File(s)
-
Is it a Closed Session Event?
Yes

Closed Session Summary Posted After the Event

The following committee members were present at the closed sessions of the event:

Donald Berwick (chair)
Adil Haider
John Holcomb
Brent James
Jorie Klein
Doug Kupas
Ellen MacKenzie
David Marcozzi
John Parrish
Rita Redberg
James Robinson
Tom Scalea
Bill Schwab

The following topics were discussed in the closed sessions:

The committee discussed its approach to address the Summary of Key Response Issues

The following materials (written documents) were made available to the committee in the closed sessions:

The Committee's draft response to the Summary of Key Response Issues
The Committee's draft response to all reviewer comments
Compiled report draft
Priority list for committee discussion
Recommendation list
Report conclusions with associated findings
Report abstract
Updated Chapter 6 of report

Date of posting of Closed Session Summary:
April 26, 2016
Publication(s) resulting from the event:

-


Location:

Teleconference
Event Type :  
-

Registration for Online Attendance :   
NA

Registration for in Person Attendance :   
NA


If you would like to attend the sessions of this event that are open to the public or need more information please contact

Contact Name:  Autumn Downey
Contact Email:  adowney@nas.edu
Contact Phone:  202-334-2046

Agenda
This meeting was closed in its entirety.
Supporting File(s)
-
Is it a Closed Session Event?
Yes

Closed Session Summary Posted After the Event

The following committee members were present at the closed sessions of the event:

Don Berwick (chair)
John Parrish
Ellen MacKenzie
Philip Spinella
John Holcomb
Ellen Embrey
Joe McCannon
Bill Schwab
David Marcozzi
James Robinson

The following topics were discussed in the closed sessions:

The committee discussed its approach to address the Summary of Key Response Issues

The following materials (written documents) were made available to the committee in the closed sessions:

The Committee's draft response to the Summary of Key Response Issues

Date of posting of Closed Session Summary:
April 04, 2016
Publication(s) resulting from the event:

-


Location:

Teleconference
Event Type :  
-

Registration for Online Attendance :   
NA

Registration for in Person Attendance :   
NA


If you would like to attend the sessions of this event that are open to the public or need more information please contact

Contact Name:  Autumn Downey
Contact Email:  adowney@nas.edu
Contact Phone:  202-334-2046

Agenda
This meeting was closed in its entirety.
Supporting File(s)
-
Is it a Closed Session Event?
Yes

Closed Session Summary Posted After the Event

The following committee members were present at the closed sessions of the event:

Don Berwick (chair)
John Parrish
Sara Goldkind
Doug Kupas
Adil Haider
David Marcozzi
James Robinson
Ellen Embrey

The following topics were discussed in the closed sessions:

The committee discussed its approach to address the Summary of Key Response Issues

The following materials (written documents) were made available to the committee in the closed sessions:

The Summary of Key Response Issues (SKRI)

Date of posting of Closed Session Summary:
April 04, 2016
Publication(s) resulting from the event:

-


Location:

Teleconference
Event Type :  
-

Registration for Online Attendance :   
NA

Registration for in Person Attendance :   
NA


If you would like to attend the sessions of this event that are open to the public or need more information please contact

Contact Name:  Autumn Downey
Contact Email:  adowney@nas.edu
Contact Phone:  202-334-2046

Agenda
This meeting was closed in its entirety.
Supporting File(s)
-
Is it a Closed Session Event?
Yes

Closed Session Summary Posted After the Event

The following committee members were present at the closed sessions of the event:

Don Berwick (Committee Chair)
Ellen Embrey
Sara Goldkind
Adil Haider
John Holcomb
Brent James
Jorie Klein
Douglas Kupas
David Marcozzi
Joseph McCannon
James Robinson
Thomas Scalea
C. William Schwab

The following topics were discussed in the closed sessions:

During the two-hour teleconference, the committee discussed their approach to respond to reviewer comments.

The following materials (written documents) were made available to the committee in the closed sessions:

Compiled list of reviewer comments
Staff-generated list of themes emerging from reviewer comments

Date of posting of Closed Session Summary:
March 29, 2016
Publication(s) resulting from the event:

-


Location:

Teleconference
Event Type :  
-

Registration for Online Attendance :   
NA

Registration for in Person Attendance :   
NA


If you would like to attend the sessions of this event that are open to the public or need more information please contact

Contact Name:  Autumn Downey
Contact Email:  adowney@nas.edu
Contact Phone:  202-334-2046

Agenda
This meeting was closed in its entirety.
Supporting File(s)
-
Is it a Closed Session Event?
Yes

Closed Session Summary Posted After the Event

The following committee members were present at the closed sessions of the event:

Don Berwick (Committee Chair)
Sara Goldkind
John Holcomb
Brent James
Jorie Klein
Doug Kupas
Ellen MacKenzie
David Marcozzi
Joe McCannon
John Parrish
Rita Redberg
James Robinson
Tom Scalea

The following topics were discussed in the closed sessions:

During the two-hour teleconference, the committee discussed their approach to respond to reviewer comments.

The following materials (written documents) were made available to the committee in the closed sessions:

Compiled list of reviewer comments
Staff-generated list of themes emerging from reviewer comments

Date of posting of Closed Session Summary:
March 21, 2016
Publication(s) resulting from the event:

-


Location:

Teleconference
Event Type :  
-

Registration for Online Attendance :   
NA

Registration for in Person Attendance :   
NA


If you would like to attend the sessions of this event that are open to the public or need more information please contact

Contact Name:  Autumn Downey
Contact Email:  adowney@nas.edu
Contact Phone:  202-334-2046

Agenda
February 5, 2016

3:00 p.m. – 3:10 p.m. Welcome and Introduction

DON BERWICK, Committee Chair
President Emeritus and Senior Fellow
Institute for Healthcare Improvement

3:10 p.m. – 3:30 p.m. The Role of the Service Surgeons General in a Military Learning Trauma Care System

LT GEN MARK EDIGER
Surgeon General for the U.S. Air Force
U.S. Department of Defense

DR. MICHAEL MALANOSKI
Executive Director
U.S. Navy Bureau of Medicine and Surgery
U.S. Department of Defense

3:30 p.m. – 4:00 p.m. Discussion with Committee

4:00 p.m. Adjourn Open Session
Supporting File(s)
-
Is it a Closed Session Event?
No

Publication(s) resulting from the event:

-


Location:

Keck Center
500 5th St NW, Washington, DC 20001
Event Type :  
-

Registration for Online Attendance :   
NA

Registration for in Person Attendance :   
NA


If you would like to attend the sessions of this event that are open to the public or need more information please contact

Contact Name:  Autumn Downey
Contact Email:  adowney@nas.edu
Contact Phone:  202-334-2046

Agenda
The meeting is closed in its entirety.
Supporting File(s)
-
Is it a Closed Session Event?
Yes

Closed Session Summary Posted After the Event

The following committee members were present at the closed sessions of the event:

- Donald Berwick (chair)
- Ellen Embrey
- Adil Haider
- John Holcomb
- Brent James
- Douglas Kupas (by phone)
- Cato Laurencin (on 1/15/16 only)
- Ellen MacKenzie
- David Marcozzi
- C. Joseph McCannon
- John Parrish
- Rita Redberg
- James Robinson
- Thomas Scalea
- C. William Schwab
- Phillip Spinella

The following topics were discussed in the closed sessions:

Thursday, January 14, 2016:
- Work plan and project timeline
- Report recommendations
- Report draft and organization

Friday, January 15, 2016:
- Report recommendations
- Report draft and organization
- Case study approach
- Commissioned papers
- Report dissemination and impact

The following materials (written documents) were made available to the committee in the closed sessions:

- Updated agenda for the committee meeting
- Directions and map for hotel/dinner
- Updated list of findings, conclusions, and recommendations
- Updated report outlines
- Color printed compilation of report figures and tables
- Draft case study boxes on dismounted complex blast injury and pediatric trauma
- Minutes from call with U.S. Department of Defense representatives
- Campion et al. 2016. Reconsidering the resources needed for multiple casualty events: Lessons learned from the crash of Asiana Airlines Flight 214. JAMA Surgery doi:10.1001/jamasurg.2015.5107
- Operational clinical skills list—basic competencies of an Air Force nurse in the deployed environment
- Readiness skills verification checklist for Air Force critical care nurse

Date of posting of Closed Session Summary:
January 19, 2016
Publication(s) resulting from the event:

-


Location:

Web-based Teleconference
Event Type :  
-

Registration for Online Attendance :   
NA

Registration for in Person Attendance :   
NA


If you would like to attend the sessions of this event that are open to the public or need more information please contact

Contact Name:  Autumn Downey
Contact Email:  adowney@nas.edu
Contact Phone:  -

Agenda
January 5, 2016

2:00 p.m. – 2:10 p.m. Welcome and Introductions

DON BERWICK, Committee Chair
President Emeritus and Senior Fellow
Institute for Healthcare Improvement

2:10 p.m. – 3:00 p.m. Nursing in the Context of a Learning Health System

COL (RET) ELIZABETH BRIDGES
Associate Professor
University of Washington School of Nursing

LT COL JENNIFER HATZFELD
En Route Care Portfolio Manager, Combat Casualty Care Research Program
U.S. Department of Defense

KATE FITZPATRICK
Senior Vice President and Chief Nursing Officer
University of Vermont Medical Center

THERESE RICHMOND
Andrea B. Laporte Endowed Professor of Nursing and Associate Dean for Research and Innovation
University of Pennsylvania

MAJOR GENERAL MARGARET WILMOTH
Deputy Surgeon General for Mobilization, Readiness and Army Reserve Affairs, Office of the Surgeon General, U.S. Army
U.S. Department of Defense

3:00 p.m. – 4:00 p.m. Discussion with Committee

4:00 p.m. Adjourn Open Session
Supporting File(s)
-
Is it a Closed Session Event?
No

Publication(s) resulting from the event:

-


Location:

Teleconference
Event Type :  
-

Registration for Online Attendance :   
NA

Registration for in Person Attendance :   
NA


If you would like to attend the sessions of this event that are open to the public or need more information please contact

Contact Name:  Autumn Downey
Contact Email:  adowney@nas.edu
Contact Phone:  202 334-2046

Agenda
December 2, 2015
9:00 a.m. – 9:10 a.m. Welcome and Meeting Objectives

DON BERWICK, Committee Chair
President Emeritus and Senior Fellow
Institute for Healthcare Improvement

9:10 a.m. – 10:00 a.m. The Role of Leadership in a Learning Trauma Care System

ADM (RET) MICHAEL MULLEN
President/CEO, MGM Consulting, LLC
17th Chairman, Joint Chiefs of Staff

10:00 a.m. Adjourn Open Session
Supporting File(s)
-
Is it a Closed Session Event?
No

Publication(s) resulting from the event:

-


Location:

Keck Center
500 5th St NW, Washington, DC 20001
Event Type :  
-

Registration for Online Attendance :   
NA

Registration for in Person Attendance :   
NA


If you would like to attend the sessions of this event that are open to the public or need more information please contact

Contact Name:  Autumn Downey
Contact Email:  adowney@nas.edu
Contact Phone:  202.334.2046

Agenda
The meeting was closed in its entirety.
Supporting File(s)
-
Is it a Closed Session Event?
Yes

Closed Session Summary Posted After the Event

The following committee members were present at the closed sessions of the event:

- Donald Berwick (chair)
- Ellen Embrey
- Sara Goldkind
- Adil Haider
- John Holcomb
- Brent James
- Jorie Klein
- Douglas Kupas
- Ellen MacKenzie
- David Marcozzi
- C. Joseph McCannon
- John Parrish
- James Robinson
- C. William Schwab
- Phillip Spinella

The following topics were discussed in the closed sessions:

Thursday, November 12, 2015:
- Discussion of unresolved issues
- Content of draft chapters
- Discussion on IOM report review process
- Discussion of report dissemination and impact
- Format and organization of the report

Friday, November 13, 2015:
- Commissioned paper on military-civilian exchange
- Commissioned paper on trauma data
- Case study approach
- Additional information gathering needs
- Planning for potential web-based conference
- Preliminary findings, conclusions, and recommendations
- Work plan and project timeline

The following materials (written documents) were made available to the committee in the closed sessions:

- Updated agenda for the closed and open sessions of the committee meeting
- Directions and map for hotel/dinner
- Preliminary list of recommendations
- Preliminary list of components, gaps, and recommendations
- Preliminary list of high priority trauma research needs
- Preliminary list of military-civilian translation practices
- Alternative report structures
- Draft figures on the diffusion of innovations in EMS
- Draft commissioned paper on trauma data
- Draft case study boxes
- Draft report text on leadership
- IOM. 2007. Hospital-based emergency care: At the breaking point. Washington, DC: The National Academies Press. (selected sections)

Date of posting of Closed Session Summary:
November 16, 2015
Publication(s) resulting from the event:

-


Location:

WebEx
Event Type :  
-

Registration for Online Attendance :   
NA

Registration for in Person Attendance :   
NA


If you would like to attend the sessions of this event that are open to the public or need more information please contact

Contact Name:  Autumn Downey
Contact Email:  adowney@nas.edu
Contact Phone:  202.334.2046

Agenda

12:00 p.m. – 12:10 p.m. Welcome and Introductions

DON BERWICK, Committee Chair
President Emeritus and Senior Fellow
Institute for Healthcare Improvement

12:10 p.m. – 1:00 p.m. EMS in the Context of a Learning Health System

SCOTT BOURN
Senior Vice President of Quality Measurement and Improvement
Evolution Health

DIA GAINOR
Executive Director
National Association of State EMS Officials

DAVID PAGE
Director, Prehospital Care Research Forum
University of California, Los Angeles

SEVERO RODRIGUEZ
Executive Director
National Registry of Emergency Medical Technicians

1:00 p.m. – 2:00 p.m. Discussion with Committee

2:00 p.m. Adjourn Open Session
Supporting File(s)
-
Is it a Closed Session Event?
No

Publication(s) resulting from the event:

-


Location:

Keck Center
500 5th St NW, Washington, DC 20001
Event Type :  
-

Registration for Online Attendance :   
NA

Registration for in Person Attendance :   
NA


If you would like to attend the sessions of this event that are open to the public or need more information please contact

Contact Name:  Autumn Downey
Contact Email:  adowney@nas.edu
Contact Phone:  202.334.2046

Agenda
September 16, 2015
Room K206

8:30 a.m. – 8:40 a.m. Welcome and Meeting Objectives

DON BERWICK, Committee Chair
President Emeritus and Senior Fellow
Institute for Healthcare Improvement


WORKSHOP SESSION I: ETHICAL AND REGULATORY ISSUES
Session Facilitator: Sara Goldkind
Session Objectives: To explore the ethical and regulatory issues that influence the design and functioning of a learning system for trauma care in both military and civilian sectors.

8:40 a.m. – 11:00 a.m. Facilitated Panel Discussion on Ethical and Regulatory Issues

Regulatory Perspective:

LAURA BROSCH
Director, Office of Research Protections
U.S. Army Medical Research and Material Command
U.S. Department of Defense

LUCIANA BORIO
Acting Chief Scientist
U.S. Food and Drug Administration
U.S. Department of Health and Human Services

JERRY MENIKOFF
Director, Office for Human Research Protections
U.S. Department of Health and Human Services

CHRISTINA HEIDE
Senior Advisor for HIPAA Policy Office for Civil Rights
U.S. Department of Health and Human Services

Field Practitioner Perspective:

NEAL DICKERT (By Teleconference)
Assistant Professor of Medicine Division of Cardiology
Emory University School of Medicine

CHUCK CAIRNS
Assistant Vice President
Clinical Research and Clinical Trials
Arizona Health Sciences Center
The University of Arizona College of Medicine

CHARLES BRANAS (By Teleconference)
Professor of Epidemiology
University of Pennsylvania


WORKSHOP SESSION II: TRAUMA RESEARCH INVESTMENT
Session Facilitator: John Holcomb
Session Objectives: To determine the adequacy of current research investments in view of the burden of trauma and the possibilities for improvement of care and outcomes, and to recommend needed changes.

11:00 a.m. – 12:15 p.m. Panel Discussion on Trauma Research Investment

NICOLE DI RESTA
Senior Vice President
Cassidy and Associates

JEREMY BROWN
Director, Office of Emergency Care Research
National Institutes of Health
U.S. Department of Health and Human Services

COL TODD RASMUSSEN
Director, Combat Casualty Care Research Program
U.S. Army Medical Research and Material Command
U.S. Department of Defense

ANDREW POLLAK
The James Lawrence Kernan Professor and Chair Department of Orthopaedics
University of Maryland School of Medicine
Chief of Orthopaedics
University of Maryland Medical System

MARY WOOLLEY
President
Research!America


12:15 p.m. – 1:00 p.m. Lunch


WORKSHOP SESSION III: COMMISSIONED PAPERS

1:00 p.m. – 2:00 p.m. Discussion of Commissioned Papers with Committee

ELLIOTT HAUT
Associate Professor of Surgery and Anesthesiology & Critical Care Medicine, Department of Surgery
Johns Hopkins Medicine

RUSS KOTWAL (By Teleconference)
Independent Medical Consultant

CLAY MANN (By Teleconference)
Professor, Department of Pediatrics
University of Utah School of Medicine

JEREMY CANNON
Instructor in Surgery
Perelman School of Medicine
University of Pennsylvania

2:00 p.m. – 2:15 p.m. Public Comment Period

2:15 p.m. Adjourn Open Session

September 17, 2015
Room K206

8:00 a.m. – 9:00 a.m. Joint Trauma System Video Teleconference

9:00 a.m. Adjourn Open Session
Supporting File(s)
-
Is it a Closed Session Event?
Yes

Closed Session Summary Posted After the Event

The following committee members were present at the closed sessions of the event:

- Donald Berwick (chair)
- Sara Goldkind
- John Holcomb
- Jorie Klein
- Douglas Kupas
- Cato Laurencin (on 9/17/15 only)
- Ellen MacKenzie
- David Marcozzi
- C. Joseph McCannon
- John Parrish
- Rita Redberg (on 9/16/15 only)
- James Robinson (by phone)
- Phillip Spinella

The following topics were discussed in the closed sessions:

Wednesday, September 16, 2015:
- Discussion on ethical and regulatory issues that influence a learning system for trauma care
- Discussion on IOM report review process
- Draft report outline and framework for trauma system evaluation
- Case study approach and template

Thursday, September 17, 2015:
- Key messages for the report
- Additional information gathering needs and research projects in progress
- Planning for potential November workshop and web-based conference, including information needs, workshop topics and potential speakers
- Discussion on civilian EMS
- Draft report outline
- Conflict of interest and potential sources of bias discussion for new committee member, per National Academies procedure
- Potential recommendation areas and preliminary findings
- Work plan and project timeline

The following materials (written documents) were made available to the committee in the closed sessions:

- Updated agenda for the closed and open sessions of the committee meeting
- Open session speaker biosketches
- Directions and map for hotel/dinner
- Preliminary list of findings
- Preliminary list of high priority trauma research needs
- Preliminary list of preventable trauma mortality statistics
- Preliminary list of questions to determine how well a system facilitates learning and improvement
- Draft template form for analyzing the case studies
- Draft case study adapted to the civilian setting
- Draft Chapter 1 of the report
- Cannon, J. 2015. Draft outline for commissioned paper on military-civilian exchange of knowledge and practices in trauma care.
- Haut, E. R., N. C. Mann, and R. S. Kotwal. 2015. Draft outline for commissioned paper on trauma data.
- Goldkind, S. 2015. A Brief Look at Two Components of a LHCS. (PowerPoint presentation handout).
- Holcomb, J. 2015. The Burden of Trauma and Trauma Research Investment. (PowerPoint presentation handout).
- Kupas, D. 2015. Overview of Civilian EMS. (PowerPoint presentation handout).
- Briere, R. 2015. Five Qualities of an Impactful NRC Report.
- American College of Surgeons. 2015. Strategies to Enhance Survival in Active Shooter and Intentional Mass Casualty Events: A Compendium. Bulletin of the American College of Surgeons 100(1S).

Date of posting of Closed Session Summary:
September 18, 2015
Publication(s) resulting from the event:

-


Location:

National Academy of Sciences Building
2101 Constitution Ave NW, Washington, DC 20418
Event Type :  
-

Registration for Online Attendance :   
NA

Registration for in Person Attendance :   
NA


If you would like to attend the sessions of this event that are open to the public or need more information please contact

Contact Name:  Autumn Downey
Contact Email:  adowney@nas.edu
Contact Phone:  202-334-2046

Agenda
July 23, 2015
OPEN SESSION

10:00 a.m. – 10:10 a.m. Welcome and Meeting Objectives

DON BERWICK, Committee Chair
President Emeritus and Senior Fellow
Institute for Healthcare Improvement


WORKSHOP SESSION I: LEADERSHIP AND ACCOUNTABILITY

10:10 a.m. – 10:30 a.m. Military Sector Panel

LT GEN DOUG ROBB
Director, Defense Health Agency
U.S. Department of Defense

RADM (RET) DAVID SMITH
Deputy Assistant Secretary of Defense for
Health Readiness Policy and Oversight
U.S. Department of Defense

10:30 a.m. – 11:15 a.m. Discussion with the committee

11:15 a.m. – 12:00 p.m. Civilian Sector Panel

DAVID HOYT
Executive Director, American College of Surgeons

PAUL PATRICK
President, National Association of State EMS Officials
Deputy Division Director, Utah Department of Health Division of Family Health and Preparedness

LENWORTH JACOBS
Director of Trauma and Emergency Medicine, Vice President of Academic Affairs and Chief Academic Officer
Hartford Hospital

BRENDAN CARR
Director, Emergency Care Coordination Center
U.S. Department of Health and Human Services

12:00 p.m. – 12:45 p.m. Discussion with the committee

12:45 p.m. – 1:30 p.m. Lunch


WORKSHOP SESSION II: TRAUMA DATA AND INFORMATION SYSTEMS

1:30 p.m. – 1:45 p.m. Military Sector Panel

MARY ANN SPOTT
Deputy Director, Joint Trauma System
U.S. Department of Defense

COL (RET) BRIAN EASTRIDGE
Professor of Surgery, Jocelyn and Joe Straus Endowed Chair in Trauma Research
University of Texas Health Science Center

1:45 p.m. – 2:00 p.m. Civilian Sector Panel

AVERY NATHENS
Director, Trauma Quality Improvement Program
American College of Surgeons
Chief of Surgery, Sunnybrook Health Sciences Centre

MARK BARNES
Partner, Ropes and Gray, LLP

2:00 p.m. – 2:45 p.m. Discussion with the committee


WORKSHOP SESSION III: CLINICAL GUIDELINE DEVELOPMENT

2:45 p.m. – 3:00 p.m. Military Sector Panel

CAPT ZSOLT STOCKINGER
Director of Performance Improvement
Joint Trauma System
U.S. Department of Defense

CAPT (RET) FRANK BUTLER
Chair, Committee on Tactical Combat Casualty Care
Director of Pre-Hospital Trauma Care
Joint Trauma System
U.S. Department of Defense

3:00 p.m. – 3:30 p.m. Civilian Sector Panel

CAROLYN CLANCY
Chief Medical Officer,
U.S. Department of Veterans Affairs

SUSAN KIRSH (FOR Q&A ONLY)
National Director, Clinic Practice Management for Clinical Operations and Access
U.S. Department of Veterans Affairs

PETER TAILLAC
Clinical Professor, Division of Emergency Medicine,
University of Utah School of Medicine
Medical Director, Bureau of EMS and Preparedness
Utah Department of Health
Colonel, Medical Corps
State Surgeon, Utah Army National Guard

DAVID CALLAWAY
Co-Director, Committee on Tactical Emergency Casualty Care
Associate Professor of Emergency Medicine
Carolinas Medical Center

3:30 p.m. – 4:15 p.m. Discussion with the committee

4:15 p.m. – 4:30 p.m. Break


WORKSHOP SESSION IV: EDUCATION AND TRAINING FOR READINESS

4:30 p.m. – 5:15 p.m. Military Sector Panel

CHARLES RICE
President, Uniformed Services University of the Health Sciences
U.S. Department of Defense

BRIG GEN ROBERT MILLER
Director, Defense Health Agency Education and Training Directorate
Commandant, Medical Education and Training Campus
U.S. Department of Defense

COL RAYMOND FANG
Director, U.S. Air Force Center for Sustainment of Trauma and Readiness Skills (C-STARS)-Baltimore
U.S. Department of Defense

LTC JASON SEERY
Director, U.S. Army Trauma Training Center
U.S. Department of Defense

CAPT (RET) PETER RHEE
Professor of Surgery and Chief, Division of Trauma, Critical Care, Burn and Emergency Surgery
University of Arizona

ALEC BEEKLEY
Associate Professor, Thomas Jefferson University Hospitals

5:15 p.m. – 6:00 p.m. Discussion with the committee

6:00 p.m. – 6:15 p.m. Public Comment Period

6:15 p.m. Adjourn Open Session


July 24, 2015
OPEN SESSION

8:00 a.m. – 10:00 a.m. Discussion of Draft Case Studies with Committee

LTC ANDREW CAP
Chief, Blood Research
U.S. Army Institute of Surgical Research
U.S. Department of Defense

KATHRYN BRINSFIELD
Assistant Secretary for Health Affairs and Chief Medical Officer
U.S. Department of Homeland Security

DREW DAWSON
Director of the Office of Emergency Medical Services
National Highway Traffic Safety Administration
U.S. Department of Transportation

DAVID HOYT (BY TELECONFERENCE)
Executive Director, American College of Surgeons

ALLEN YEE
National Association of EMS Physicians

STEVEN MERCER (BY TELECONFERENCE)
National Association of EMTs

JOHN OSBORN
Trauma Center Association of America

10:00 a.m. – 10:45 a.m. Closing Keynote

GEN (RET) PETER CHIARELLI
Chief Executive Officer, One Mind

10:45 a.m. Adjourn Open Session
Supporting File(s)
-
Is it a Closed Session Event?
Yes

Closed Session Summary Posted After the Event

The following committee members were present at the closed sessions of the event:

- Donald Berwick (chair)
- Ellen Embrey
- Sara Goldkind
- Adil Haider
- John Holcomb
- Brent James
- Jorie Klein
- Douglas Kupas
- Ellen MacKenzie
- David Marcozzi
- C. Joseph McCannon
- John Parrish
- Rita Redberg
- Thomas Scalea
- C. William Schwab
- Phillip Spinella

The following topics were discussed in the closed sessions:

Thursday, July 23, 2015:
- Discussion on aims and components of optimal trauma systems
- Discussion on aims and components of learning health systems

Friday, July 24, 2015:
- Key messages from open session presentations
- Potential recommendation areas
- Conflict of interest and potential sources of bias discussion for new committee member, per National Academies procedure
- Work plan and project timeline
- Potential site visit
- Commissioned papers
- Planning for September workshop, including information needs, workshop topics and potential speakers
- Draft report outline
- Committee composition

The following materials (written documents) were made available to the committee in the closed sessions:

- Updated agenda for the closed and open sessions of the committee meeting
- Open session speaker biosketches and attendee list
- Directions and map for hotel/dinner
- Preliminary list of recommendations
- Preliminary list of identified gaps
- Proposed panels for September workshop
- Draft itinerary for potential site visit
- Committee developed questions for speakers
- Draft case studies
- MacKenzie, Ellen. 2015. Critical Components of a Regionalized Trauma System (with a focus on civilian trauma systems).
- Schwab, C. William. 2015. Attachment: A Brief History of the Development of Trauma Systems.
- McCannon, C. Joseph. 2015. Creating a Learning Health System that Drives Rapid Improvement. (PowerPoint presentation handout).
- Butler, Frank. 2015. Institute of Medicine Tactical Combat Casualty Care Information Package.
- Butler, F. K., D. J. Smith, and R. H. Carmona. 2015. Implementing and preserving the advances in combat casualty care from Iraq and Afghanistan throughout the US military. J Trauma Acute Care Surg 79(2):1-6.
- Butler, Frank. 2015. Improving Prehospital Trauma Care in the United States Military: Tactical Combat Casualty Care. (PowerPoint presentation handout).
- Callaway, David. 2015. Institute of Medicine Committee on Military Trauma Care’s Learning Health System and its Translation to the Civilian Sector. (PowerPoint presentation handout).
- Miller, Brig. Gen. Robert. 2015. IOM Committee on Military Trauma Section IV: Education and Training for Readiness. (PowerPoint presentation handout).
- Robb, Lt. Gen. Douglas. 2015. The Why. (PowerPoint presentation handout).
- Smith, David. 2015. Saved Lives on the Battlefield. (PowerPoint presentation handout).
- Stockinger, CAPT Zsolt. 2015. Clinical Practice Guidelines. (PowerPoint presentation handout).

Date of posting of Closed Session Summary:
July 28, 2015
Publication(s) resulting from the event:

-


Location:

National Academy of Sciences Building
2101 Constitution Ave NW, Washington, DC 20418
Event Type :  
-

Registration for Online Attendance :   
NA

Registration for in Person Attendance :   
NA


If you would like to attend the sessions of this event that are open to the public or need more information please contact

Contact Name:  Crysti Park
Contact Email:  cpark@nas.edu
Contact Phone:  202.334.1814

Agenda
May 18, 2015

SESSION II: SPONSOR BRIEFING: DISCUSSION OF THE COMMITTEE’S CHARGE
Session Objective: To hear from the sponsors of the study regarding their perspectives on the charge to the committee.


10:15 a.m. Welcome and Introductions

DON BERWICK, Committee Chair
President Emeritus and Senior Fellow
Institute for Healthcare Improvement


10:30 a.m. Federal Perspectives on Charge to the Committee

COL. TODD RASMUSSEN
Director, Combat Casualty Care Research Program
U.S. Army Medical Research and Materiel Command
U.S. Department of Defense

ARTHUR KELLERMAN
Dean, F. Edward Hebert School of Medicine
Uniformed Services University of the Health Sciences

KATHRYN BRINSFIELD
Assistant Secretary for Health Affairs and Chief Medical Officer
U.S. Department of Homeland Security

DREW DAWSON
Director of the Office of Emergency Medical Services
National Highway Traffic Safety Administration
U.S. Department of Transportation


11:30 a.m. Discussion with Committee


12:00 p.m. Professional Organization Perspectives on Charge to the Committee

DAVID HOYT (BY TELECONFERENCE)
Executive Director
American College of Surgeons

M. MARGARET KNUDSON (BY TELECONFERENCE)
Medical Director
American College of Surgeons Military Health System Strategic Partnership
CRAIG MANIFOLD
American College of Emergency Physicians

JULIO LAIRET
Government Services Chapter
American College of Emergency Physicians

ALLEN YEE
National Association of EMS Physicians

STEVEN MERCER
National Association of EMTs

JOHN OSBORN
Trauma Center Association of America


12:50 p.m. Discussion with Committee


1:15 p.m. Lunch


SESSION III: ADDITIONAL CONTEXT FOR THE STUDY
Session Objective: To obtain additional background information and context for the study.


2:00 p.m. White House Initiative on Bystander Interventions for Life-Threatening Traumatic Hemorrhage

RICHARD HUNT
Director for Medical Preparedness Policy
National Security Council Staff
The White House


2:15 p.m. Discussion with Committee


2:30 p.m. Overview of the Department of Defense Trauma System Elements

COL KIRBY GROSS
Director, Joint Trauma System
U.S. Department of Defense

DAVID BAER
Deputy Director, Combat Casualty Care Research Program
U.S. Army Medical Research and Materiel Command
U.S. Department of Defense

LTC ANDREW CAP
Chief, Blood Research
U.S. Army Institute of Surgical Research
U.S. Department of Defense


3:15 p.m. Discussion with Committee


3:45 p.m. Public Comment Period


4:00 p.m. ADJOURN OPEN SESSION
Supporting File(s)
-
Is it a Closed Session Event?
Yes

Closed Session Summary Posted After the Event

The following committee members were present at the closed sessions of the event:

-Donald Berwick (chair)
-Ellen Embrey
-Sara Goldkind
-Adil Haider
-John Holcomb
-Jorie Klein (by phone on 5/18/15 only)
-Douglas Kupas
-Cato Laurencin (on 5/19/15 only)
-Ellen MacKenzie
-David Marcozzi
-C. Joseph McCannon (by phone)
-Norman McSwain
-John Parrish
-Rita Redberg (on 5/18/15 only)
-Uwe Reinhardt
-Thomas Scalea
-C. William Schwab
-Phillip Spinella (by phone)

The following topics were discussed in the closed sessions:

Monday, May 18, 2015:
- Welcome by Committee Chair and committee introductions
- Conflict of interest and potential sources of bias discussion, per National Academies procedure
- Committee charge and questions for the sponsors on the statement of task
- Speaker presentations from the open session
- Committee’s statement of task and how to approach it

Tuesday, May 19, 2015:
- Work plan, project timeline, and information gathering strategies
- Committee charge and statement of task
- Planning for July and September workshops, including information needs, workshop topics and potential speakers
- Preliminary report outline
- Conflict of interest and potential sources of bias discussion for committee member absent from Day 1 discussion, per National Academies procedure
- Background on the IOM Learning Health System model
- Committee composition
- Potential site visit

The following materials (written documents) were made available to the committee in the closed sessions:

- Updated agenda for the closed and open sessions of the committee meeting
- Open session speaker biosketches and attendee list
- Draft statement of task
- Travel and logistics memorandum, directions for hotel/dinner, and instructions for reporting travel expenses
- Draft timeline for the study process
- Rasmussen, Todd. 2015. Federal Perspectives on Charge to the Institute of Medicine Committee. (PowerPoint presentation handout).
- Dawson, Drew. 2015. Charge to the Institute of Medicine Committee on Military Trauma Care’s Learning Health System and its Translation to the Civilian Sector. (PowerPoint presentation handout).
- Manifold, Craig, and Lairet, Julio. 2015. American College of Emergency Physicians: Military Trauma Care’s Learning Health System and its Translation to the Civilian Sector. (PowerPoint presentation handout).
- Mercer, Steven. 2015. Medical Training for U.S. Armed Services Medical Personnel and All Other Combatants. (PowerPoint presentation handout).
- Gross, Kirby. 2015. Joint Trauma System. (PowerPoint presentation handout).
- Baer, David. 2015. Military Medical Research Investment in Combat Casualty Care. (PowerPoint presentation handout).
- Cap, Andrew. 2015. Mission Planning. (PowerPoint presentation handout).
- McGinnis, Michael. 2015. An Overview of the IOM Learning Health System Model. (PowerPoint presentation handout).
- Preliminary report outline

Date of posting of Closed Session Summary:
May 22, 2015
Publication(s) resulting from the event:

-

Publications