Up to 1 in 5 deaths from car crashes, gunshots or other injuries might be prevented with better, quicker trauma care that doesn't depend so much on where you live, according to government advisers — advice that takes on new urgency amid the increasing threat of mass casualties like the massacre in Orlando.
The Orlando shooting happened just blocks from a major trauma care hospital, an accident of geography that undoubtedly saved lives. But Friday's call to action found swaths of the country don't have fast access to top care, and urges a national trauma system that puts the military's battlefield expertise to work at home.
The ultimate goal: Zero preventable deaths after injury, and minimizing disability among survivors, said the National Academies of Sciences, Engineering and Medicine. It called on the White House to lead that effort.
Today, there's no way to be sure "the current best trauma care is going to reach you no matter where you are," warned Dr. Donald Berwick of the Institute for HealthCare Improvement, who chaired the NAS committee. "The meter is running on these preventable deaths."
The report found a patchwork of care, from disjointed systems of first responders to death rates that vary twofold between the nation's best and worst trauma centers.
Yet the biggest opportunity to save lives comes before anyone reaches a trauma center: About half of deaths occur at the scene of the injury or enroute to the hospital — and the military has proven that both bystanders and well-trained emergency medical services can make a big difference.
"The answer's always been to drive faster or fly faster. We're almost at the limit of that. Minutes really do count in these critically ill patients. But we can do things to stop bleeding, resuscitate better, while we're flying or driving faster," said panelist Dr. John Holcomb, a former Army colonel now at the University of Texas Health Science Center in Houston.
Trauma is the leading cause of death for Americans 45 and younger, killing nearly 148,000 people in 2014 alone and costing a staggering $670 billion in medical expenses and lost productivity.
The report estimated that about 20 percent of deaths could be prevented based on improvements in trauma care the military made after the start of the wars in Iraq and Afghanistan.
But the military, too, can continue to make improvements — including a big need to ensure that those hard-won combat lessons aren't lost in peacetime. One way to do that is to allow military surgeons to do more work in civilian trauma centers, the report said.