A tracking system developed to monitor and treat wounded troops in Iraq and Afghanistan has proven invaluable in the U.S. military's fight against the COVID-19 pandemic, defense health officials said Monday.
The Defense Department's joint trauma system, created in 2004 to collect information on casualties, treatments and outcomes to determine what worked -- or didn't -- in saving lives in combat, is being used during the pandemic to gather real-time data on COVID-19 patients, according to Dr. Paul Cordts, chief medical officer at the Defense Health Agency.
The information is leading to more widespread use of effective treatments, Cordts said.
As of Monday, the DoD has had 36,659 total cases of COVID-19, including 960 hospitalizations and 56 deaths, since the first military patient was diagnosed with the illness Feb. 24 in the Republic of Korea.
With the need for better care, military physicians have been uploading patient information, approaches and outcomes, just as they do with operations and training injuries.
"We leveraged the lessons learned from OIF/OEF in creating the Joint Pain or Trauma Registry, the Joint Trauma System, to inform our COVID-19 registry. Part of the power of that registry is real-time data and information," Cordts said during a call with reporters Monday.
In 2004, the Defense Department directed the individual services to establish a trauma registry. The collected data and reporting on treatments led to life-saving changes to protocols, including increased use of tourniquets, changes to administering blood transfusions, the use of freeze-dried plasma and response during the "Golden Hour" -- the first 60 minutes following a traumatic injury.
A dozen years later, those overseeing the Joint Trauma System were given the authority to establish trauma care guidelines and make recommendations to the services, combatant commanders and the Defense Health Agency on best practices.
The ability to share data nearly instantaneously on every DoD patient with COVID-19 has helped with treatment of the currently incurable illness. Using feedback from physicians across the system who are treating patients, DoD providers have been using remdesivir, the experimental drug first developed to combat Ebola, as well as convalescent plasma and dexamethasone, an anti-inflammatory that has shown promise in treating patients on ventilators, to treat hospitalized victims, Cordts said.
"We can evaluate our therapies in real time and adjust our clinical practice guidelines if need be toward those therapies that appear to be most effective. I think that was a great learning piece for us, leveraging the lessons we learned during OIF/OEF," he said.
"With traditional implementation of innovation, we would most likely have a randomized controlled trial, some rigorous multi-year study that proves the efficacy of a given treatment," added Air Force Col. Todd Rasmussen, associate dean of research at the Uniformed University of the Health Sciences (USUHS). "In certain clinical situations, that's just not feasible. We don't have the time. ... It's a sort of alternative, rapid-cycle innovation near real time."
In addition to using the DoD Trauma Registry in a new, creative way, DoD medical personnel have developed resources for physicians and medical devices for patients to improve well-being and decrease transmission of the contagious illness.
According to Dr. Simon Pincus, director of the Connected Health Branch at the DHA, the DoD created an online "provider resilience suite" that contains apps for meditation and mindfulness, as well as tips to identify burnout and provide self care.
"When you're a provider in combat, you are also not going home from the trauma -- you are potentially at risk as a victim. This is kind of similar to what providers are doing on the front lines [of COVID-19]. ... They are at risk for the same outcome, so one of the innovations we developed was this suite for self care," Pincus said.
More helpful in protecting providers and other patients from airborne droplets of the SARS-CoV-2 virus emitted when COVID-19 patients exhale, talk, cough or sneeze is the "COVID-19 airway management isolation chamber," or CAMIC, a $15 box made of PVC pipe and plastic sheeting that can be placed on a patient's head before he or she needs to be intubated or requires other close medical interventions involving the neck or head.
The box allows physicians and other medical personnel to conduct procedures on a patient while they receive fresh air and suction.
The CAMIC, developed by a team of military medical personnel led by Army Maj. Steven Hong, assistant professor of surgery at USUHS received an emergency use authorization from the Food and Drug Administration in June.
At its peak, the CAMIC was used about 25 times a day since it received emergency approval, according to Hong. There are currently 60 devices across the military health system: 15 at the Walter Reed National Military Medical Center, Bethesda, Maryland; five at Fort Belvoir Army Community Hospital in Virginia; 30 at William Beaumont Army Medical Center, El Paso, Texas; and 10 at Madigan Army Medical Center in Washington.
Hong said the prospect of shortages of personal protective equipment drove him to build a device to protect his fellow health care workers.
"If anything was a surprise during this process of creation and innovation was the level of leadership and institutional support here at Walter Reed and the Defense Health Agency for what really was a grassroots effort," he said.
Cordts added that the DoD's $5.5 billion electronic health records system has been useful in places where it currently is being used. According to Cordts, patients have been able to upload answers to questionnaires to determine whether they need to come into a medical facility or can be treated at home.
"We can keep low-risk people at home and identify patients that are appropriate for testing or identify those that need further care," he said.