Before the deployment of automated medical information systems to Southwest Asia, medics and nurses captured detailed trauma data on a three-page paper form. The form was stuffed into Service members’ medical files and later shipped to the states.

On the receiving end, a team of medical coders hand jammed the trauma reports into the Joint Theater Trauma Registry (JTTR). This data flow could span up to nine months. As a result, it generated a tremendous backlog of combat trauma data.

Senior leaders and researchers poured over the information as it became available. They used real medical data to identify ways to save lives on the battlefield through improved protective equipment and better battlefield healthcare processes.

In December 2007, the Army’s battlefield electronic medical recording program and automated medical logistics program, Medical Communication for Combat Casualty Care (MC4), deployed a mechanism to digitally capture and transmit trauma data to the U.S. Army Institute of Surgical Research (USAISR) at Fort Sam Houston, Texas, where the JTTR data resides.

MC4 fielded JTTR on ruggedized laptops to 12 tri-service trauma coordinators dispersed throughout Southwest Asia in support of Operations Iraqi and Enduring Freedom. Capturing trauma data via JTTR on the MC4 system accelerated the data collection and analysis process, while ensuring critical trauma-related data was not lost due to poor connectivity via MC4’s store-and-forward capability.

To date, more than 40,000 trauma cases populate the trauma database, while the data collection timeline has been slashed from months to days. Decision makers have access to current battlefield data to make more immediate recommendations on improving the care and safety of U.S. warriors.

Medical analysts and statisticians mine the JTTR data, conducting in-depth studies on a wide variety of combat-related medical issues, including head trauma, and the development of new protective gear.

“A lot of data was captured from the Vietnam War on paper forms, but it took 10 years to analyze the information to help Service members,” said MC4 Product Manager Lt. Col. William Geesey. “With the assistance of MC4 systems, researchers were able to look at wound patterns and identify the places on the body that needed greater coverage of body armor. The electronic data was rapidly communicated to materiel developers, who were able to enhance the equipment and get the improved armor out to the Soldiers, thus improving survivability.”

Trend analysis remains an important command and control element of JTTR, providing details that help commanders red flag areas of need or concern.

“It is invaluable to have the ability to document the trauma mechanisms to assist in indentifying trends, such as sniper activity,” said Air Force Capt. Myrna Spencer, trauma nurse coordinator (TNC) with the 79th Medical Operations Squadron in Baghdad, Iraq. “We’ve also been able to identify potential training or equipment concerns related to vehicle rollovers.”

Trends directly related to providing battlefield trauma care have helped refine clinical practice guidelines (CPGs), a compilation of suggested evidence-based treatment plans approved by USAISR for the management of a specific diagnosis or injury. Administrators use JTTR to track CPG compliance and to identify factors that influence non-compliance, such as resource limitations, provider preference and patient survivability.

Maj. Bing Tan-Winters, a TNC assigned to the 332nd Expeditionary Medical Group in Balad, Iraq, previously deployed to Iraq in 2006. She often wondered if patients received the proper treatment and what happened to the trauma patients after they left the treatment facility. Tracking patient data using JTTR helps answer those questions. Using the JTTR and the CPGs to outline the care being provided for trauma patients, TNCs host weekly conference calls to discuss and coordinate the best treatment options for the patients, the care patients receive and their medical progress.

“We identify potential issues with the care administered to the wounded warriors and look at areas of care that might need to be improved in a given facility,” Maj. Tan-Winters said. “We review the electronic charts and track compliance of the CPGs. We also educate the deployed medical staff on the importance of the CPGs when treating trauma patients.”

Using JTTR as a performance and process improvement tool, facilities run various reports based upon more than 160 data elements collected on each patient. The reports help to pinpoint deviations of care, from hospital-associated infections to delayed or missed diagnoses. TNCs are then armed to provide real-time feedback to hospital commanders, doctors and nurses regarding any deviations and convey recommendations for improvement. From start to finish, JTTR condenses the time required to review trauma data.

“I would spend up to two weeks to perform a specific query with paper records,” Capt. Spencer said. “In minutes, I can search multiple files to answer broad questions, such as how many women were admitted to the facility. I can also answer more focused questions, such as how many Iraqi women under the age of 35 were admitted with burns. The queries return the patient’s name and inpatient record.”

JTTR also helps validate the effectiveness of new lifesaving procedures. “Data has shown a reduction of deaths when tourniquets and hemostatic dressings are used on a hemorrhaging extremity,” Capt. Spencer said. “This evidence helps to demonstrate the importance of training every Service member how to administer critical first aid.”

The data collected in JTTR continues to provide valuable battlefield that aids follow-on trauma care.

“The information gathered by TNCs is available to researchers who are investigating everything from body armor performance during battle to the resources needed to adequately care for patients upon arrival at a level II or level III treatment facility,” Capt. Spencer said. “I am proud to know that the data I enter into the JTTR system will benefit future Service members.”

For more information regarding the on-going trauma registry efforts with MC4, visit www.mc4.army.mil.