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Defence Health

ADF Military Surgery

Scope of Research

Advances in trauma care on the modern battlefield, along with improvements in personal protective equipment, have decreased the case fatality rate by 50% in comparison to that in the Vietnam War (Holcomb et al., J.Trauma, 2006). Much of this improvement has been attributed to better trauma systems design, application of the principles of damage control surgery, better management of the coagulopathy of trauma, and application of modern intensive care close to the point of wounding. However, developments in the understanding of critical illness, traumatic brain injury, haemorrhage control and the design of trauma systems, amongst others, promise even further improvements.
Priority areas for research performed by or undertaken in collaboration with the Defence Chair of Military Surgery and Medicine include:

  • Fluid resuscitation in trauma, including effectiveness of frozen red cells and platelets in trauma resuscitation, the modulation of trauma-induced coagulopathy and inflammation, novel methods of preserving and delivering blood clotting factors, and developments in circulatory access devices;
  • Acute cognitive impairment, including characterisation and initial treatment of mild and severe traumatic brain injury and critical illness delirium;
  • Traumatic lung injury, including pharmacological and ventilator management of lung injury sustained in blunt or blast trauma;
  • Sepsis in trauma, including early diagnosis of sepsis and identification of infecting organisms using molecular diagnostics and investigation of methods to reduce bacterial translocation across the bowel wall;
  • Design of trauma systems, investigating the effectiveness of initial damage control surgery in smaller hospitals compared with longer transport times to major trauma centres, the effect of team training on efficiency and safety, and the utility of telemedicine for clinical management and governance.
Projects in each of these areas are, or will be, performed in collaboration with civilian institutions and are expected to benefit to both civilian and military trauma patients. As such, the research programme will be funded largely by competitive extramural grants by 2014-2016.
7 December, 2011