title: Military-to-civilian translation of battlefield innovations in operative trauma care.
abstract: BACKGROUND
  Historic improvements in operative trauma care have been driven by war. It is unknown whether recent battlefield innovations stemming from conflicts in Iraq/Afghanistan will follow a similar trend. The objective of this study was to survey trauma medical directors (TMDs) at level 1-3 trauma centers across the United States and gauge the extent to which battlefield innovations have shaped civilian practice in 4 key domains of trauma care.
  
  
  METHODS
  Domains were determined by the use of a modified Delphi method based on multiple consultations with an expert physician/surgeon panel: (1) damage control resuscitation (DCR), (2) tourniquet use, (3) use of hemostatic agents, and (4) prehospital interventions, including intraosseous catheter access and needle thoracostomy. A corresponding 47-item electronic anonymous survey was developed/pilot tested before dissemination to all identifiable TMD at level 1-3 trauma centers across the US.
  
  
  RESULTS
  A total of 245 TMDs, representing nearly 40% of trauma centers in the United States, completed and returned the survey. More than half (n = 127; 51.8%) were verified by the American College of Surgeons. TMDs reported high civilian use of DCR: 95.1% of trauma centers had implemented massive transfusion protocols and the majority (67.7%) tended toward 1:1:1 packed red blood cell/fresh-frozen plasma/platelets ratios. For the other 3, mixed adoption corresponded to expressed concerns regarding the extent of concomitant civilian research to support military research and experience. In centers in which policies reflecting battlefield innovations were in use, previous military experience frequently was acknowledged.
  
  
  CONCLUSIONS
  This national survey of TMDs suggests that military data supporting DCR has altered civilian practice. Perceived relevance in other domains was less clear. Civilian academic efforts are needed to further research and enhance understandings that foster improved trauma surgeon awareness of military-to-civilian translation.
authors.affiliation: Center for Surgery and Public Health, Harvard Medical School and Harvard School of Public Health, Department of Surgery, Brigham & Women's Hospital, Boston, MA. Electronic address: ahhaider@partners.org.
authors.forename: Adil H
authors.initials: AH
authors.lastname: Haider
authors.affiliation: Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Lydia C
authors.initials: LC
authors.lastname: Piper
authors.affiliation: Center for Surgery and Public Health, Harvard Medical School and Harvard School of Public Health, Department of Surgery, Brigham & Women's Hospital, Boston, MA.
authors.forename: Cheryl K
authors.initials: CK
authors.lastname: Zogg
authors.affiliation: Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Eric B
authors.initials: EB
authors.lastname: Schneider
authors.affiliation: Department of Medicine, Uniformed Services University of Health Sciences, Washington, DC.
authors.forename: Jean A
authors.initials: JA
authors.lastname: Orman
authors.affiliation: Department of Military and Emergency Medicine, Uniformed Services University of Health Sciences, Bethesda, MD.
authors.forename: Frank K
authors.initials: FK
authors.lastname: Butler
authors.affiliation: Department of Emergency Medicine, Brooke Army Medical Center, JBSA-Fort Sam Houston, Houston, TX.
authors.forename: Robert T
authors.initials: RT
authors.lastname: Gerhardt
authors.affiliation: Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Elliott R
authors.initials: ER
authors.lastname: Haut
authors.affiliation: Department of General Surgery, University of Miami/Jackson Memorial Medical Center, Miami, FL.
authors.forename: Jacques P
authors.initials: JP
authors.lastname: Mather
authors.affiliation: Department of Health Policy and Management, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
authors.forename: Ellen J
authors.initials: EJ
authors.lastname: MacKenzie
authors.affiliation: Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Diane A
authors.initials: DA
authors.lastname: Schwartz
authors.affiliation: Department of Anesthesiology, Reading Health System, West Reading, PA.
authors.forename: David W
authors.initials: DW
authors.lastname: Geyer
authors.affiliation: Department of Surgery, University of Maryland School of Medicine, Baltimore, MD.
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: DuBose
authors.affiliation: Department of Surgery, University of Maryland School of Medicine, Baltimore, MD.
authors.forename: Todd E
authors.initials: TE
authors.lastname: Rasmussen
authors.affiliation: Department of Surgery, Brooke Army Medical Center, JBSA-Fort Sam Houston, Houston, TX.
authors.forename: Lorne H
authors.initials: LH
authors.lastname: Blackbourne
mesh_terms: D055826:Afghan Campaign 2001-; D003697:Delphi Technique; D006489:Hemostatic Techniques; D006801:Humans; D062069:Inventions / Q000639:trends*; D054542:Iraq War, 2003-2011; D008887:Military Medicine / Q000639:trends*; D012151:Resuscitation / Q000379:methods; D013514:Surgical Procedures, Operative / Q000639:trends*; D011795:Surveys and Questionnaires; D014111:Tourniquets; D057170:Translational Research, Biomedical / Q000639:trends*; D014193:Trauma Centers / Q000639:trends*; D014481:United States