Military Trauma

Clinical Knowledge Gaps

& Research Opportunities

COL Brian Eastridge, MD, FACS

Trauma Consultant, US Army Surgeon General
JTS, USAISR
 Disclaimer

The opinions or assertions contained

herein are the private views of the
author and are not to be construed as
official or as reflecting the views of
the Department of the Army or the
Department of Defense.
 Military Trauma Research
Gaps
Point of Injury / Pre-hospital Care
Relevant and realistic documentation
solutions for pre-hospital care providers
Life saving intervention efficacy
Validation concepts Tactical Combat
Casualty Care

3
 Military Trauma Research
Gaps
Hemorrhage
Local and systemic hemostatic agents for the
control of compressible and non-compressible
hemorrhage
Improved preservation, storage,
transportability, and processing of red blood
cells, platelets, and plasma
Forward adaptability of damage control
resuscitation concepts

4
 Military Trauma Research
Gaps
Hemorrhage
Treatments to enhance oxygen delivery and
perfusion
Equipment and procedures for effective fluid
resuscitation of casualties
Enhanced / optimized resuscitation fluids
DOW
Non-Survivable Etiology

Eastridge et al, J Trauma 2011

DOW
Potentially Survivable Etiology

Eastridge et al, J Trauma 2011

DOW (Potentially Survivable)
Hemorrhage Focus

Eastridge et al, J Trauma 2011

 Military Trauma Research
Gaps
Coagulopathy
Diagnostics and therapeutics to predict,
diagnose, prevent, and treat trauma
coagulopathy
Noninvasive or minimally invasive sensors
to detect and warn of impending vascular
collapse and/or significant tissue damage
due to perfusion deficits

9
 Blood / Coagulation
Near Horizon
Transition of Freeze-Dried
Plasma and Cryo-Preserved
Platelets to Advanced
Development (clinical trials)
Current Focus Areas
Understanding basic
mechanisms of trauma-
induced coagulopathy
Developing improved
platelet storage systems
Developing blood product
pathogen reduction
technologies
 Military Trauma Research
Gaps
Orthopaedic Trauma
Healing of segmental bone defects
Prevention of heterotopic ossification
Healing of massive soft tissue defects
Tissue viability assessment and wound
irrigation / debridement technologies
Wound Infection / Infection Control

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 Military Trauma Research
Gaps
Massive Soft Tissue Injury
Drugs, devices, or novel surgical
techniques to decontaminate, debride,
protect, and stabilize hard and soft
tissue wounds to mitigate secondary
tissue damage
Replacement or regeneration of lost
tissues / organs

12
Extremity Trauma &
Regenerative Medicine
Defining the injury patterns
and resulting functional
outcomes
Open fractures
Soft tissue defects (muscle and
nerve)
Wound irrigation and debridement
Current Focus Areas
Animal modeling of traumatic injury
Segmental defects
Wound contamination and infection
Muscle / bone regeneration
Delivery of autologous stem cells to
treat defects
 Battlefield Injury
Upper Shoulder/Upper
Shoulder/Upper Arm
Arm 6%
Brain Injury (TBI) 12%

Extremities Forearm/Elbow
Forearm/Elbow 6%
6%
Face
Face 7%
7%
Head/Neck
Wrist/Hand/Fingers
Wrist/Hand/Fingers 7% Eye 3%
22% 7% Eye 3%
Other
Other 3%
3% Head/Neck
Head/Neck 2%
2%
27%
Head/Neck
Head/Neck Unspec
Unspec 3%
3%

Spine/Back 3%
3%

3%
Chest 5% Hip/Upper Leg/Thigh 5%
Lower
Abdomen
Abdomen 6%
6% Knee/Lower
Knee/Lower Leg/Ankle
Leg/Ankle 9%
9% Extremities
Torso Pelvis/
Pelvis/ Urogenital
Urogenital 3%
3% Foot/Toes
Foot/Toes 5%
5% 31%
15% Trunk/Back/Buttock
Trunk/Back/Buttock 1%
1% Other 12%

Other 2%
 Military Trauma Research
Gaps
Traumatic Brain Injury
Mitigation secondary brain/spinal cord
damage
Non- or minimally-invasive sensors or
assays to rapidly diagnose the severity of
brain and spinal cord injury within the battle
area or as close to it as possible
Drugs, biologics, or other agents to mitigate
post-injury neural and immune cell over-
stimulation, inflammation, cell loss, and
neurologic dysfunction 15
 Military Trauma Research
Gaps
Secondary cell and organ damage
Ischemia/reperfusion injury
Cell death
Organ failure
Methods to reduce cellular demand for
oxygen and metabolic substrates
Reframing physiologic maintenance
Demand versus supply
Therapeutics to modulate the immune
response to traumatic injury
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 Military Trauma Research
Gaps
Battlefield and En-route Pain
Management
Minimal effects on physical and
cognitive performance for mission
capability
Minimize cardiac and respiratory
depression
Minimal or no potential for addiction

17
 Pain Control
Opportunities
Novel agents / uses existing agents
Battlefield, MTF, and enroute
Regional pain therapy
Defining the relationship between pain control and Post Traumatic Stress Disorder
Nontraditional therapies
Virtual reality immersive
environments for pain control
Acupuncture
 Military Trauma Research
Gaps
Evacuation of the Critically
Injured Casualty
Hypobaria effects in stratevac
Physiological effects of vibration, shock and G-
forces
Development of non-invasive sensors, diagnostic
and prognostic algorithms and processors for
remote triage, monitoring, and management of
casualties
Decision support (computer assisted)
Autonomous control systems
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 Military Trauma Research
Gaps
Burn
Viable transitional skin products to
austere environments
Protecting skin grafts from immune
recognition
Replacement and regeneration of
skin

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 Military Trauma Research
Gaps
Eye, Ear and Craniofacial Injury
Prevention and treatment of
craniofacial and dental injury /
disease in austere environments
Craniofacial reconstruction
alternatives
Transplantation
Tissue regeneration

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Questions?