US

Combat Casualty Care

Research Program
THOR
RDCR Symposium

Col Michael Davis

US CCCRP Director
June 26, 2017
 Acknowledgments
Combat Casualty Care Research Program
Dr. David Baer LTC David Johnston
Dr. Bonnie Woffenden Col (sel) AntoineJe Shinn
Dr. Therese West Dr. Tammy Crowder
Dr. Savita Nigam Dr. Marcello Pilia
Dr. Anne RiJer Mr. Ron Palmer
Dr. Crystal Hill-Pryor Mr. Robert Sarvaideo
Dr. Arthi Amin Ms. Cindy EndicoJ
Ms. Elisabeth Flessner Mr. Ramin Khalili
Ms. Teresa Hendrickson Ms. Claudia Larin
Ms. Andrea Steele Ms. Nsini Umoh
Ms. Irene Taliaferro Ms. Kamilah Brown
 Overview
•  Strategy - Mission, Strategic Vision
•  Structure of CCC Research Program
•  Review of new guidance & guidance document
•  Lines of effort & new iniXaXves within these:
1. Streamline internal processes
2. Clinical relevance in all we do
3. Make use of strategic partnerships
4. Forward leaning scien?fic excellence
 Combat Casualty Care
Research Program
•  CCCRP is a requirements-driven, medical research &
development program
–  charged to plan, program, budget and oversee the execuXon of
a DoD RDT&E equity dedicated to the topic of military trauma
or combat casualty care.

•  Vision: OpXmize survival & recovery from combat related

injury in current & future operaXonal scenarios
•  Mission: Drive medical innovaXon through development
of knowledge & materiel soluXons for the acute & early
management of combat related trauma including point of
injury, en-route & facility based care.
 Military Medical Research

Rasmussen,T.E., Baer, D.G., Doll, B.A. & Carvallo, J. (2015). Golden Hour. Army AL&T
CCCRP Por`olio Structure
As maJer of organizaXon,
the investment aligns with
physiologic systems or
locaXons of care
 Informed & MulX-Disciplinary
Por`olios
JPC-6 Combat Casualty
Care Research Program

Neuro- En-route Forward Surgical Medical Hemorrhage

trauma Care Intensive Care Photonic Resuscitation

•  Guided by steering commiJee comprised of joint service reps,

SMEs, combat & advanced developers, CoEs, service consultants
•  Managers conform investment (PAs, BAA selecXon, RFPs)
according to requirements & steering commiJee direcXon
•  Managers coordinate with AD to chair or co-chair WGs or IPTs
 Integrated Research Program
ARMY DHA
Program Area Joint Program
Directorate Committee
MRMC (JPC-6)
(PAD-2)
Approximate $28M* Approximate $91M*

Army Extramural &

LABs Intramural
*estimates not for official use

Coordinated, programmed,
Joint research
ImperaXve for Combat
Casualty Care

NaXonal Academies of Sciences, Engineering, and Medicine.

A NaXonal Trauma Care System: IntegraXng Military and
Civilian Trauma Systems to Achieve Zero Preventable Deaths
Acer Injury. Washington, DC: The NaXonal Academies Press,
2016. doi:10.17226/23511.
 Partnership with NASEM & NEJM

“As Important as what the military’s learning health

system produced is how these advances were made –
through focused empiricism align with requirements-
driven, life-cycle medical research and development”
 Clinical Relevance of the Research
Program
•  Components of Military’s Learning Health System
- Data-driven performance improvement (culture of PI)
- Requirements-driven medical research & development
- Agile, evidence supported clinical pracXce guidelines

•  Concept of Focused Empiricism linking data, pracXce &

performance improvement
 Combat Casualty Care Research Program (CCCRP)
Mission and Focus Areas
Drive medical innovation through development of knowledge and materiel solutions for the
acute and early management of combat-related trauma, including point-of-injury, out-of-
hospital, and facility-based care.

Science
Hemorrhage Control Forward Surgical, En Pre-Hospital Tactical Neurotrauma &
and Resuscitation Route, and Critical Combat Casualty Care Traumatic Brain Injury
Care

THREATS THREATS THREATS THREATS
Non-Compressible Burn Injuries TraumaKc Bleeding Moderate / Severe
Bleeding
Cardiovascular

TraumaKc Brain
MulKple-Organ DecompensaKon Injuries
Impaired Blood Failure and

CloIng Blast-Related

InfecKon TraumaKc Airway

ObstrucKon and Concussions
LimitaKons on Complex Injuries Tension
Blood Product involving Bone, Pneumothorax Prolonged / Delayed
Supply Nerve, and SoW Medical EvacuaKon
Pain

Prolonged / Tissues

Delayed Medical
Mass CasualKes
Lung Injuries

EvacuaKon Prolonged / Delayed

Medical EvacuaKon

Service Member
 Plan According to Requirements

January - March 2015

Plan Comes from Requirements
 Plan for Research Comes from Data

J Trauma Acute Care Surg 2012;73(Suppl1):S431-S437

•  Of 4,596 warXme casualXes, 87% occurred in

prehospital senng; of those, 76% non-survivable
but 24% (N=976) were potenXally survivable…
Plan for Research Comes from Data

91% from
hemorrhage

J Trauma Acute Care Surg 2012;73(Suppl1):S431-S437

 Plan for Research Comes from Data
Extremity

JuncXonal Truncal

J Trauma Acute Care Surg 2012;73(Suppl1):S431-S437

 2016 DCAS Study of Casualty Care in
Afghanistan & Iraq
•  Analysis of Mortality During Recent Wars: Case
Fatality Rate has decreased but Died of Wounds
has increased Compared to Vietnam. Nessen SC.
“Analysis shows increase in DOW rates in OIF & OEF
compared to Vietnam and higher mortality contrasted to
matched civilian trauma paXents. Considering the resource
limitaXons of OIF & OEF, these outcomes may be
acceptable. However, considering it’s unlikely ample
resources will be available in future military conflicts,
efforts must be made to opXmize casualty care in resource
constrained environments.”
 2016 DCAS Study of Casualty Care in
Afghanistan & Iraq

“Above all, we must not allow ourselves to fight the next

war based on excessively opXmisXc assumpXons about our
capabiliXes in the past war.” Nessen SC, et al.
 CCC Research Program
Forward-leaning S&T to deliver soluXons for future and
more complex scenarios (new focus of DASA(R&T)
-  Refocus S&T efforts to mid-
term (recapitalizaXon)
-  New $ (15% over POM) for
2 new tasks
-  Prolonged Field Care &
Endovascular ResuscitaXon
-  Focus towards AI,
automaXon, decision- 18 January 2017
support, tele-enabled care &
miniaturizaXon
AnXcipaXng the Charge

J Trauma Acute Care Surg 2015;79(4):S61-S63

 Combat Casualty Care
Research Program

J Trauma Acute Care Surg 2015;79(4):S61-S63

AnXcipaXng the Charge

•  New golden hour capability

focused on physiology not
usual fixed echelons of care
 AnXcipaXng the Charge

•  Unmanned casualty evacuaXon

– In senng of MulX-domain BaJlefield, PFC
– Decision support/ automated systems/ tele-
intervenXon

•  HBOCs/ oxygen carriers

•  Organ support/ECLS
 Thank You

“ex scien?a ad bellum” - from science to the baOlefield

 CCC Research Program
•  Strategic Lines of Effort
Clinical relevance in all we do - ensure innovaXon
benefits the injured (JTS & other clinical communiXes)

CCCRP
DCoE DCoE
Army RAD & Labs

Defense Health
Program
AF 711th HPW

MTFs / CI
AF 59th MW
NAMRU

NMRC
USU

Clinical Clinical
Questions Guidance