American College of Emergency Physicians

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1 American College of Emergency Physicians Military Trauma Cares Learning Health System and its Translation to the Civilian Sector Craig Manifold, DO FACEP Julio Lairet, DO FACEP 18 May 2015 Institute of Medicine Washington, DC

2 ACEP A body of emergency physicians dedicated to the enhancement and advancement of acute care of our patients 32,000 emergency physicians throughout the US Additional members include international physicians, residents, subspecialties, physician s assistants etc. Collaborative working body with colleagues who affect emergency care Primary entity in US representing emergency physicians Supports education, research, public outreach

3 Government Services Chapter ACEP (GSACEP) 1,500 members Federally affiliated emergency physicians Majority with military service Annual education meeting Members in CONUS/OCONUS

4 Personal Background Enlisted medics in USAF Served as active duty emergency physicians with combat experience Assisted in development and deployment of Critical Care Transport Teams and Mobile Field Surgical Teams Board certified and currently serve as civilian EMS Medical Directors Active educators and researchers Continue military service in the National Guard

5 Perspective on Charge to the Committee Primary concern related to prehospital and initial hospital care Systems development and integration Point of injury care En-route care Initial resuscitation Evidence Guided Key component Identify differences in environment and patient population which could alter translation

6 Education Models Didactics case based/flipped classroom Simulation CSTARS concept Draw down/force shaping --- integration with civilian ems agencies and facilities Live tissue/fresh cadaver availability Clearly identify levels of evidence associated Shared Clinical Practice Guidelines

7 Clinical Data Transmission and Analysis How Storage Why? Process Improvement and Quality Assurance

8 Current Examples Tourniquet application Almost universally adopted in EMS Application Removal? Tranexamic Acid Current helicopter trials anticipated Current use: administered in 50% patients who do not have uncontrolled hemorrhage Surgical airway management Morbidly obese patient

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11 Combat Medical Environment

12 En-route Care

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15 Gathering of Eagles 25 largest municipalities EMS Medical Directors Weekly, if not daily interchanges Collaborative research framework Willingness to participate in process improvement activities Ex Ketamine implementation

16 Albuquerque 1 MIL Anchorage 1 MIL Atlanta 500,000 Austin 1 MIL Boston 649,000 Chicago 2.8 MIL Cincinnati 1.2 MIL Dallas 2 MIL Denver 1.2 MIL Ft. Lauderdale 2.5 MIL Ft. Worth 880,000 Greenville 474,000 Houston 2.2 MIL Indianapolis 1.3 MIL Kansas City 450,000 Los Angeles 4 MIL Memphis 1.3 MIL Miami 500,000 Minneapolis 1.2 MIL Nashville 1 MIL New Orleans 400,000 Oakland 1.5 MIL Oklahoma City 1.25 MIL Orange Co. 1.2 MIL Philadelphia 1.5 MIL Pittsburgh 305,000 Portland 2.2 MIL Salt lake City 200,000 San Antonio 1.3 MIL San Diego 1.3 MIL San Francisco 841,000 Seattle 655,000 St. Louis 440,000 Wichita 500,000 Population Served Seattle, WA Portland, OR Salt Lake City, UT San Francisco, CA Chicago, IL Cincinnati, OH Denver, CO Oklahoma City, OK San Diego, CA Albuquerque, NM Memphis, TN Ft. Worth, TX Atlanta, GA Austin, TX Anchorage, AK New Orleans, LA Houston, TX Boston, MA New York, NY Philadelphia, PA Ft. Lauderdale, FL Population < 1 million million > 1.5 million

17 Number of Providers Seattle, WA Portland, OR Boston, MA San Francisco, CA Salt Lake City, UT Chicago, IL Cincinnati, OH New York, NY Philadelphia, PA Denver, CO Oklahoma City, OK San Diego, CA Albuquerque, NM Memphis, TN Ft. Worth, TX Atlanta, GA Austin, TX New Orleans, LA Anchorage, AK Houston, TX Ft. Lauderdale, FL < > 2000

18 Total Number of Calls Seattle, WA Portland, OR Boston, MA Chicago, IL New York, NY Philadelphia, PA San Francisco, CA Denver, CO Los Angeles, CA Albuquerque, NM Oklahoma City, OK Memphis, TN Dallas, TX Atlanta, GA Austin, TX New Orleans, LA Anchorage, AK Houston, TX Ft. Lauderdale, FL 100,000 Calls 100, ,000 Calls 200,000 + Calls

19 Emergency Medicine Prehospital Potential Outreach Population served 71 million Providers 94,000 Annual response 8.9 million Municipal, Fire, Hospital based EMS agencies

20 Opportunities ACEP and GSACEP welcome the opportunity to provide input and collaborate with other organizations and entities Appreciative of the organizations participating today

21 ACEP and GSACEP Recognize the challenges of this project Appreciate the emphasis and resourcing to develop translation strategies for trauma care Standing by to assist

22 Contact acep.org gsacep.org Mobile

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