The Department of Defense (DOD) Combat Casualty Care Research Program has granted researchers working with the Cape-Colorado-Combat (C3) Global Trauma Network at the University of Colorado School of Medicine $15.6 million to establish a platform to study important questions related to prolonged care for patients with major bleeding, traumatic brain injury (TBI), polytrauma, and complex wounds – injuries often seen in South Africa and modern battlefield settings.
“Our main goal is to advance knowledge in the areas of trauma resuscitation amongst critically injured patients in resource-limited settings, which have prolonged durations of care,” says Nee-Kofi Mould-Millman, MD, PhD, MSCS, professor of emergency medicine and principal investigator of the C3 Global Trauma Network, a program dedicated to researching optimal trauma resuscitation and care.
The grant is the largest yet for the C3 Global Trauma Network, which partners with researchers, clinicians, and leaders in the Western Cape province of South Africa, which experiences some of the highest rates of trauma, particularly penetrating trauma, in the world. The grant builds on a decade-long history of trauma-focused collaborations between Mould-Millman’s group and South Africa.
Due to their significant resource-constraints and prolonged durations of care amid an overwhelming trauma patient load, South African clinicians have led innovations in trauma care and attained mastery in prolonged care resuscitation.
Over the next six years, the researchers will work to study trauma care to improve outcomes for South Africans, U.S. military service members, and civilian populations around the globe. Data collection for observational and epidemiologic research projects will serve as the foundation, and their research platform will accommodate additional interventional studies, including clinical trials.
The DOD funding helps to solve trauma care challenges that are present in both civilian and military populations. While South Africans will primarily benefit from the research, there are important lessons for the U.S. military, which attributes about 67% of combat deaths to dangerous bleeding.
Mould-Millman says it’s critical that the research takes place in a high-trauma location that mimics the limited resources that military medical personnel operate with while deployed.
“If a service member is wounded in battle, medical teams only have what they can carry along to resuscitate the patient,” Mould-Millman says. “In future conflicts, forward resuscitation and surgical units may be stranded for 24 to 48 hours with bare bones resources while they’re trying to keep multiple critically injured service members alive. The South African trauma care system provides contextually-relevant data and knowledge products to help address several of these challenges.”
As a result, this research can span several different populations and communities that experience challenges related to delays in reaching a major trauma center. Polytrauma, for example, accounts for about a quarter of major trauma hospital admissions in high income countries. In the U.S. military, about 19% of service members have sustained open wounds in recent military conflicts. Complications develop in as many as half of those cases.
Army Lt. Col. Steven Schauer, DO, MS, RDMS, instructor of emergency medicine and fellow with Anesthesia Critical Care Medicine and the CU Center for Combat Medicine and Battlefield (COMBAT) Research, will assist on the project, which stems from work he and Mould-Millman have been collaborating on since 2017.
“It’s exciting to be moving into an arena where we have interventional studies,” Schauer says. “We can actually look at one particular intervention and assess the outcomes in a military-relevant population.”
The C3 team poses for a photo with collaborators from the CU Center for COMBAT Research and researchers based in South Africa. Photo courtesy of Nee-Kofi Mould-Millman, MD, PhD, MSCS.
The researchers expect their findings from more than a dozen sub-studies will be used to improve trauma care by informing clinical practice guidelines in South Africa, the U.S. military and beyond.
For Mould-Millman, success of the platform will be defined by the contemporary questions the group will be able to answer around optimal resuscitation and prolonged care treatment. Fortunately, he says, an exceptional team has assembled to take on the task.
“We’re lucky here at C3 and CU that we have a collaborative of all the right experts,” he says. “We have surgeons and military experts like Dr. Schauer, and in South Africa we have several invested partners who are also decision makers and can shine a light into policy and practices. It’s really a great group to have on a project of this magnitude and importance.”