Tucked within the $1.1 trillion omnibus spending bill passed just before the end of 2015 is a $10 million line item for a Trauma Clinical Research Program within the Department of Defense (DOD) Health Program. The program will create a coordinated, multi-institution, clinical research network to advance the study of military-relevant topics in trauma care and trauma systems.
How that appropriation got there is a tale that starts more than 50 years ago, and includes the perseverance of a small band of trauma surgeons and the vision of the U.S. Combat Casualty Care Research Program.
Dr. Ronald Stewart
A landmark 1966 National Academy of Sciences report declared, “Research in trauma has suffered from the lack of recognition of trauma as a major public health problem … The most significant obstacle at present is the lack of long-term funding.”1 And with underfunding, predictions that the unnecessary toll of injury would persist came true.2 Under-resourced surgical societies, steep competition for a dwindling number of national grants, and no federal agency specifically directed toward injury and trauma research have led to trauma becoming one of the gravest and most costly health problems in America.
By 2014, trauma, the No. 1 killer of Americans through age 46, was claiming more than 130,000 Americans each year. Along with the tragic loss of life, trauma has become one of the most expensive medical problems in the United States. “No other ‘plague’ of this magnitude is tolerated in modern society,” bemoaned a group of public health professionals.3 Most recently, a 2015 study by the Centers for Disease Control and Prevention estimated that the annual financial toll of traumatic injury in the United States amounted to $671 billion.
It became clear to the trauma and acute care surgical community that a large-scale collaborative effort would be necessary to turn the tide on trauma research funding. Last year, five leading trauma-related societies united around one goal under one banner: the Coalition for National Trauma Research (CNTR).
CNTR, which combines the strengths of the American Association for the Surgery of Trauma (AAST), National Trauma Institute (NTI), Eastern Association for the Surgery of Trauma (EAST), American College of Surgeons Committee on Trauma (COT), and Western Trauma Association (WTA), was launched at the 2014 AAST Annual Meeting.4
These organizations are working together to advance a national trauma research agenda, build research infrastructure, and secure a sustained level of federal funding.
CNTR’s first order of business was a day of advocacy on Capitol Hill in February 2015, facilitating a total of 114 lawmaker visits for 40 surgeons from across the United States. When it was over, CNTR had gained the support of 49 House members who requested $30 million be allocated to the DOD budget for a National Clinical Trauma Research Program – a civilian, multi-institutional clinical trials network supporting Combat Casualty Care research programs. (The amount was whittled down to $10 million during the appropriations process.)
The $10 million will merely get the program off the ground, and the Department of Defense aims to build the program into its annual budget going forward. The designated network of research centers will investigate improved treatments for traumatic injuries suffered by our soldiers, many of which are similar to the injuries suffered by civilians on a massive scale, including those injuries related to traffic collisions and violence.
CNTR, now in the position to respond with research proposals, has assembled a group of more than 140 trauma centers willing to be part of the clinical trials network, once the DOD establishes it. The organization will reprise its Trauma Research Advocacy Day in Washington in February 2016, with surgeons returning to ask for the additional $20 million in start-up funding left on the table last year.
I believe this is good for all of surgery, and I know trauma research should be funded at a level commensurate with the public health problem. With the help of the Coalition for National Trauma Research, we just gained some significant traction. Please consider lending your support to this critical endeavor.
To learn more about CNTR and to get involved, visit CoalitionNTR.org.
1. Committee on Trauma and Committee on Shock, Division of Medical Sciences, National Academy of Sciences, and National Research Council. Accidental Death and Disability: The Neglected Disease of Modern Society (Washington, DC: National Academies Press, 1966).
2. Committee on the Future of Emergency Care in the United States Health System, Board on Health Care Services. Hospital-Based Emergency Care: At the Breaking Point. (Washington, DC: Institute of Medicine of the National Academies, 2006).