Letter to the Hon. Kay Granger, Chairwoman of the Subcommittee on Defense and the Hon. Peter Visclosky, Ranking Member of the subcommittee on Defense - Castro Leads Bipartisan Push for National Trauma Research Action Plan

Letter

Dear Chairwoman Granger and Ranking Member Visclosky:

As you consider the defense medical research program for FY2019, we respectfully request that you include $9.2 million in the Defense Health Program R&D account for the "National Trauma Research Action Plan," or NTRAP. The National Academies of Sciences, Engineering, and Medicine (NASEM) recommended the creation of the NTRAP in a seminal evaluation of trauma care and research in 2016. Study authors viewed the NTRAP as a critical element in a comprehensive plan to achieve a goal of zero preventable trauma deaths -- defined as a life that could have been saved by appropriate and timely medical care -- in both our military and civilian sectors. Studies have estimated that 25% of battlefield deaths and 20% of civilian deaths after injury are survivable.

Whether sustained in military service or civilian life, traumatic injury is a major public health problem. Since 2001, trauma has caused nearly 7,000 combat-related deaths. Additionally, nearly 200,000 U.S. civilians suffer a fatal injury each year; and for every death due to injury, another 3 to 4 people survive with life-limiting disabilities or pain. Injury is the leading cause of death in individuals up to the age of 46, including children.

Study authors conceived the NTRAP as a means to "strengthen trauma research and ensure that the resources available for this research are commensurate with the importance of injury and the potential for improvement in patient outcomes." Yet one study of NIH funding showed that trauma ranks last in funding compared to its burden among 27 disease categories. The NASEM report concluded that a unified effort across federal agencies is required and that the NTRAP is the mechanism to unify and focus research agendas on the most critical problems.

The principal elements of the NTRAP effort would be: performing a gap analysis of military and civilian trauma research to identify priorities across the continuum of care; defining optimal metrics to assess long-term outcomes in injured patients; cataloging current federal funding for trauma research, as currently there is no such resource; and identifying regulatory barriers to conducting trauma research, recommending best practices as well as appropriate funding levels to address critical gaps. Experts across the continuum of care would be recruited to lead in such areas as pre-hospital trauma care, mass casualty response, acute resuscitation, critical care, neurotrauma, orthopedic trauma, burns, geriatric trauma, pediatric trauma, injury prevention and rehabilitation. A steering committee with leaders from each of these areas would direct the project.

Chairwoman Granger and Ranking Member Visclosky, our military has long had the lead among federal agencies in trauma. It is time for Congress to put these sound recommendations into practice, and we believe this request will fully fund such a NASEM-recommended plan for future trauma research, leading to the stated goal of zero preventable trauma deaths.

Thank you for your consideration of our request.

Sincerely,