Weil Institute investigators will use insights from Ukraine to inform new global trauma care guidelines
Supported by a large DoD grant, researchers are on a mission to enhance combat casualty care around the world.
Contact:
Katelyn Murphy
Marketing Communications Specialist, Weil Institute
mukately@med.umich.edu
ANN ARBOR, MI – Investigators from the University of Michigan Max Harry Weil Institute for Critical Care Research and Innovation and Ethos Solutions have received a two-year, $800,000 grant through the Center for Global Health Engagement of the Uniformed Services University of the Health Sciences to perform a proof-of-concept study aimed at optimizing how emergency care is delivered at all levels in austere conflict conditions. Co-led by Dr. Florian Schmitzberger, a member of the Weil Institute and Clinical Assistant Professor of Emergency Medicine, the team will examine how key elements of clinical practice guidelines (CPGs) developed to inform trauma care delivery in the United States have been adopted and adapted for the war in Ukraine.
By conducting utilization and utility surveys on the mobilization in Ukraine, the team will produce a prospective matrix that will provide actionable recommendations and adjustments to the guidelines that are uniquely tailored and immediately relevant to the Ukrainian military and civilian healthcare systems. The insights gained from the initial study in Ukraine will be used to develop a working framework to better guide partner nations of the United States in responding to medical emergencies in large-scale combat operations. The goal is for these guidelines to be easily adopted by both civilian and military medical systems worldwide, improving outcomes and reducing casualties.
A Fact-Finding Mission to Enhance Combat Care
The clinical practice guidelines issued by the United States Joint Trauma System (JTS) offer a standardized and consistent approach to trauma care for providers of all levels in conflict conditions. Compiled from Department of Defense (DoD) Trauma Registry data, patient records, and after-action reports, these guidelines are recognized and trusted globally and have enabled the US to benefit from the lowest rates of morbidity and mortality among combat casualties in the history of modern warfare.
While Ukraine has adopted many facets of the JTS CPGs as best practices, differences in the country’s healthcare infrastructure as well as the dynamic environment of the battlefield pose unique implementation challenges that warrant data-driven exploration.
As a former army medic with experience providing direct medical training and care on the frontlines of Ukraine, Dr. Schmitzberger has observed many of these challenges first-hand.
"This whole initiative grew from seeing how Ukraine has implemented combat casualty care at all levels in clinical practice and the challenges they have faced due to the overwhelming adversary they are fighting. We are unbelievably impressed by the quality of care that they are able to provide very far forward. We are on a fact-finding mission to see how we can help refine and learn from the system."
Florian Schmitzberger, MD, MS
Clinical Assistant Professor of Emergency Medicine, University of Michigan
Member, Weil Institute
“Something we’ve noticed, for example, is a high application rate of tourniquets,” said Dr. Schmitzberger. “If you have extremity injuries, early and rapid administration of tourniquets is exceptionally useful. Yet, in Ukraine, we are also seeing some of the down-range effects of having tourniquets applied for too long or not having follow-up care. This sparked our interest in evaluating more of these recommendations and seeing how they could potentially be adjusted to meet the immediate needs within a country’s system.”
Dr. Schmitzberger emphasized that this work is not intended to criticize or “fix” the system currently in place in Ukraine. Instead, the team is extracting core elements from the JTS CPGs and engaging subject matter experts in Ukraine to determine which are essential and applicable in-country. The team will also perform a gap analysis to identify barriers that have limited the current utility of CPGs in Ukraine, such as accessibility of critical equipment and personnel, gaps in training, and differences in emergency care infrastructure.
"This whole initiative grew from seeing how Ukraine has implemented combat casualty care at all levels in clinical practice and the challenges they have faced due to the overwhelming adversary they are fighting," said Dr. Schmitzberger. “We are unbelievably impressed by the quality of care that they are able to provide very far forward. We are on a fact-finding mission to see how we can help refine and learn from the system."
Advising on the project is Dr. Kevin Ward, Executive Director of the Weil Institute and Professor of Emergency Medicine and Biomedical Engineering. “There’s not a clear battlefield in Ukraine, so civilian centers and civilian populations are now part of the battlefield landscape,” said Dr. Ward. “In addition, much of the Ukrainian army is civilian--these are people who signed up with maybe limited experience and are volunteering to protect their country.”
Dr. Ward is also a military veteran himself and co-authored some of the JTS CPGs. Previously, Dr. Ward and a team donated hundreds of a new generation of tourniquets developed by the Weil Institute to Ukraine.
“It’s an honor and a privilege to contribute in some small way to their fight to maintain their freedom,” said Ward.
Study Team
Florian Schmitzberger, MD, MS (Weil Institute, Emergency Medicine); Timothy Bryan, DO (Ethos Solutions), Jessica Patterson, MD (Ethos Solutions), Kevin Ward, MD (Weil Institute, Emergency Medicine, Biomedical Engineering)
Further Reading
· “Former army medic turned emergency physician offers training, care during Ukraine war”
About the Weil Institute
The team at the Max Harry Weil Institute for Critical Care Research and Innovation is dedicated to pushing the leading edge of research to develop new technologies and novel therapies for the most critically ill and injured patients. Through a unique formula of innovation, integration and entrepreneurship that was first imagined by Weil, their multi-disciplinary teams of health providers, basic scientists, engineers, data scientists, commercialization coaches, donors and industry partners are taking a boundless approach to re-imagining every aspect of critical care medicine. For more information, visit weilinstitute.med.umich.edu.