The Joint Trauma System (JTS), the Armed Forces Medical Examiner System (AFMES), and the Joint Trauma Analysis and Prevention of Injury in Combat (JTAPIC) met this spring to advance combat casualty care to prevent deaths resulting from potentially survivable battlefield injuries.
The JTAPIC exists to enable the prevention or mitigation of injuries to service members in the deployed environment through partnerships. The JTS is a data-driven performance improvement organization that focuses on saving lives with data; understanding mechanisms of death and opportunities to improve survivability helps close the gap in the trauma systems and improve battlefield care. The JTS is known for managing the Department of Defense Trauma Registry (DoDTR), which collects patient care data from point of injury to recovery. This landmark agreement formalizes the JTS DoDTR Trauma Registry and the AFMES mortality data-sharing efforts.
The partnership will leverage the strengths of each organization, create synergistic efforts, and allow for systematic and scalable mortality data collection, agile data sharing amongst DoD partners, and the development of cutting-edge data collection methodologies for future conflicts.
The collaboration also reinforces the Defense Health Agency (DHA) Director’s vision for DHA digital transformation. Understanding why a trauma patient dies is vital to preventing death from injuries that are potentially survivable. The AFMES—in its “making good from bad” analysis along with the analytical aid of the JTS and JTAPIC—improves not just battlefield care but also informs civilian trauma systems by adding these analyses into the continuum of care.
At the core of this partnership is mortality data collected by the AFMES, which is the only medical examiner system authorized to support the DoD. Given the sensitive nature of DoD mortality data, the organizations agreed that a highly controlled, access-restricted module in the DoDTR would provide the data abstraction capability and overall registry infrastructure needed to move forward with medical mortality data sharing. The joint analysis of AFMES data by JTS subject matter experts will influence prevention and performance improvement initiatives, emerging technologies, and academic knowledge essential for the readiness, sustainability, and survivability of US service members.
The JTS and AFMES collaborate in mortality reviews of every combat fatality to identify opportunities for improvement in battlefield care. These improvements can occur through primary prevention efforts, such as tactics, techniques, and procedures; secondary prevention efforts, such as personal protective equipment; and/or tertiary prevention efforts such as medical care. The results are preventive measures, evidence-based changes to clinical practice guidelines and combat casualty care, directed procurement of resources, and numerous presentations and publications to comprehensively inform decision-makers from both medical and non-medical leadership.
Adding JTAPIC to the JTS/AFMES partnership helps close the loop in terms of prevention, with the goal of not just saving lives on the battlefield, but also preventing injuries (i.e., better equipment). The JTAPIC works closely with manufacturers and intelligence organizations to share information and improve design. The JTAPIC Information and Collaboration System (JINCS) is an online system that facilitates rapid turnaround analyses leading to prompt and meaningful improvements in equipment, tactics, techniques, and procedures in theaters of operations and in the acquisition process.
“Mortality data have wide-ranging implications for the DoD and for our nation. The AFMES, JTS, and JTAPIC are making huge strides to improve warfighter survivability and prevent future death,” said US Air Force Forensic Pathologist Lieutenant Colonel Andrew Rohrer, MD.
The new partnership will reduce silos of effort while simultaneously creating a larger repository of military mortality data for analysis and a greater understanding of combat casualty care and prevention to support combat operations and the mission of the combatant commands. This codified partnership will also provide the structure required to fulfill the DHA mandate for formal military trauma mortality review to determine injury survivability and death preventability of military fatalities and to identify opportunities for improvement.
This is not the first collaboration between the AFMES, JTAPIC, and JTS. The JTAPIC has previously helped AFMES with data coding as there was a gap of uncoded data from 2014 to 2021. The coded AFMES data can now be sorted and analyzed, transforming registry data into actionable data. JTS hosts a monthly AFMES teleconference that discusses special cases. Understanding mechanisms of death and opportunities to improve injury survivability and preventable death helps to close gaps in the trauma system and improve combat casualty care and prevention. As leaders provide formations with their priorities of effort and enforcement of standards, data collection, and metrics must accurately inform leadership decision-making.
“Saving lives with data and making good from bad enables improvement in the trauma system and can help inform education, training, doctrine, and policy,” said Colonel Jennifer Gurney, MD, FACS, the JTS Chief and current ESS Vice-President (President-Elect).
