Surgical Critical Care Initiative (SC2i) Will Adapt Lessons of War to Complex Civilian Care

July 2014

Emory University School of Medicine; Duke University School of Medicine; Uniformed Services University of the Health Sciences; Henry M. Jackson Foundation for the Advancement of Military Medicine; Naval Medical Research Center; Walter Reed National Military Medical Center; and DecisionQ Corporation are partnering to translate remarkable advances in combat casualty care and surgical research resulting from military experiences with critically injured service members to civilian practice. Known as the Surgical Critical Care Initiative (SC2i), the collaborative effort is sponsored by the Defense Health Program of the Department of Defense (DoD). SC2i's national PI is Eric Elster, MD, professor and chairman, Norman M. Rich Department of Surgery, Uniformed Services University of the Health Sciences. Visit the SC2i's official website.

Emory was chosen as the consortium's initial civilian site because of its established role in academic surgery, its system-wide integrated critical care network that includes one of the nation's busiest Level I trauma centers at Grady Memorial Hospital, and its status as the site of an earlier DoD-funded study led by Emory surgeon-researcher Christopher Dente, MD, that is developing a wound closure algorithm similar to the DoD's formula for military casualties.

Allan Kirk, MD, PhD, former vice chair of research of the Emory Department of Surgery and now chair of the Department of Surgery at Duke University Medical Center, serves as the PI for the SC2i at Duke and oversees the SC2i's civilian investigative partnerships. Dr. Kirk is a recognized authority in organ transplantation and its related immunology and is also interested in the fundamental relationships between injury, critical illness, and immune function. Duke Hospital's Level I trauma center and critical care services possess the degree of sophistication, reputation, and large patient base that can add further benefit to the initiative’s endeavor.    

Much of the Emory-based footwork will be undertaken by local PI Timothy Buchman, PhD, MD, director of the Emory Critical Care Center (ECCC), and the afore-mentioned Dr. Dente, associate director of trauma at Grady Memorial Hospital and the partnership's site investigator at Grady. Drs. Buchman and Dente have extensive clinical and research experience in trauma and surgical critical care and lead the types of clinical services that can directly apply and evaluate the DoD's systems.

One of the byproducts of recent armed conflicts was the increase in catastrophic injuries that were survivable because of new types of body armor and the far-forward deployment of advanced medical resources. However, there were no established precedents for caring for such complex and life-threatening injuries, which resulted in treatment decisions being left to physicians' judgment. In an effort to standardize care in these extreme circumstances and control variable costs and outcomes, the DoD developed biomarker panels and decision-making algorithms that corresponded to the different types of severe injuries experienced by combat-wounded patients. The goal of the SC2i is to validate, enhance, and adapt these tools to treat critical injuries and illnesses in civilian settings and, by doing so, transmit valuable data back to the DoD to further refine its battlefield procedures.

"This program has the potential to revolutionize the way critically injured patients are cared for," says Dr. Dente. "Our goal is to work to implement real time models that will improve outcomes in surgical critical care, and do so in a more time and cost efficient manner."

Patients with acute illnesses and trauma can reach life-threatening states very rapidly, requiring split second treatment decisions that have substantial biological and fiscal implications. The challenge is to integrate the substantial amount of information available to inform those decisions in a time span that is clinically relevant. "We hope to realign the trajectory of a patient's course from a rapidly downward slope to recovery with better decision-making based on multiple sources of clinical information and biomedical data," says Dr. Kirk. "We want our medical practice to focus on what is right for a particular individual at a specific moment, and not solely on what may seem right for critical care populations in general."

The SC2i plans to achieve this goal by integrating and analyzing massive amounts of information, including immune-related data from biological samples acquired by informed consent, in real-time settings such as Emory and Duke's trauma centers and ICUs. The clinical teams will work with DecisionQ, a private company that specializes in data mining and creating mathematical, predictive models, to design a system that will swiftly pair these multiple data streams with the DoD's decision-making algorithms so that clinical professionals can receive informed recommendations for treating specific patient scenarios.

In addition to trauma and critical care, the decision-making tools that will be validated and enhanced by the SC2i are expected to help optimize outcomes across other disciplines that require complex medical decision making, including emergency medicine, orthopedics, transplantation, and oncology.

The project described was supported by Grant Number 1C1CMS331041 from the Department of Health and Human Services, Centers for Medicare & Medicaid Services. The contents of this website are solely the responsibility of the authors and do not necessarily represent the official views of the U.S. Department of Health and Human Services or any of its agencies.

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