Request for Information: Improving Prehospital Trauma Care

Jeff Michael
National Highway Traffic Safety Administration
27 April 2018

[Federal Register Volume 83, Number 82 (Friday, April 27, 2018)]
[Notices]
[Pages 18649-18651]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2018-08504]


-----------------------------------------------------------------------

DEPARTMENT OF TRANSPORTATION

National Highway Traffic Safety Administration

[Docket No. NHTSA-2018-0056]


Request for Information: Improving Prehospital Trauma Care

AGENCY: National Highway Traffic Safety Administration (NHTSA), 
Department of Transportation (DOT).

[[Page 18650]]


ACTION: Notice.

-----------------------------------------------------------------------

SUMMARY: NHTSA, on behalf of the Federal Interagency Committee on 
Emergency Medical Services (FICEMS), is seeking comments from all 
sources (public, private, governmental, academic, professional, public 
interest groups, and other interested parties) on improving prehospital 
trauma care.
    The purpose of this notice is to solicit comments on improving 
prehospital trauma care, and to request responses to specific questions 
provided below. This is neither a request for proposals nor an 
invitation for bids.

DATES: It is requested that comments on this announcement be submitted 
by July 26, 2018.

ADDRESSES: You may submit comments [identified by Docket No. NHTSA-
2018-0056] through one of the following methods:
     Federal eRulemaking Portal: http://www.regulations.gov. 
Follow the online instructions for submitting comments.
     Mail or Hand Delivery: Docket Management Facility, U.S. 
Department of Transportation, 1200 New Jersey Avenue SE, West Building, 
Room W12-140, Washington, DC 20590, between 9 a.m. and 5 p.m., Monday 
through Friday, except on Federal holidays.

FOR FURTHER INFORMATION CONTACT: Gamunu Wijetunge, Office of Emergency 
Medical Services, (202) 493-2793, gamunu.wijetunge@dot.gov, located at 
the United States Department of Transportation; 1200 New Jersey Avenue 
SE, NPD-400, Room W44-232, Washington, DC 20590. Office hours are from 
9 a.m. to 5 p.m., Monday through Friday, except Federal holidays.

SUPPLEMENTARY INFORMATION: 

Background

    FICEMS was created (42 U.S.C. 300d-4) by the Secretaries of 
Transportation, Health and Human Services and Homeland Security to, in 
part, ensure coordination among the Federal agencies involved with 
State, local, tribal or regional emergency medical services and 9-1-1 
systems. FICEMS has statutory authority to identify State and local 
Emergency Medical Services (EMS) and 9-1-1 needs, to recommend new or 
expanded programs and to identify the ways in which Federal agencies 
can streamline their processes for support of EMS. FICEMS includes 
representatives from the Department of Defense (DoD) Office of the 
Assistant Secretary of Defense Health Affairs, the Department of Health 
and Human Services (HHS) Office of the Assistant Secretary for 
Preparedness and Response (ASPR), HHS Indian Health Service (IHS), HHS 
Centers for Disease Control and Prevention (CDC), HHS Health Resources 
and Services Administration (HRSA), HHS Centers for Medicare and 
Medicaid Services (CMS), the Department of Homeland Security (DHS) 
Office of Health Affairs (OHA), DHS U.S. Fire Administration (USFA), 
NHTSA, the Federal Communications Commission (FCC) and a State EMS 
Director appointed by the Secretary of Transportation.
    In 2016 the National Academies of Sciences, Engineering, and 
Medicine (NASEM) published a report, A National Trauma Care System: 
Integrating Military and Civilian Trauma Systems to Achieve Zero 
Preventable Deaths After Injury (2016 NASEM Trauma Report), that 
estimated as many as 20 percent of the nearly of 200,000 annual trauma 
deaths in the United States could be prevented.
    On December 2, 2016 the National Emergency Medical Services 
Advisory Council (NEMSAC) issued recommendations to FICEMS in response 
to the NASEM report (https://www.ems.gov/pdf/nemsac/NEMSAC_Advisory_MTSPE_Alignment_Trauma_Care_Report.pdf). NEMSAC 
recommended that FICEMS develop an integrated Federal strategy to 
address both the recommendations of the NASEM report and the need to 
update the Model Trauma Systems Planning and Evaluation (MTPSE) 
document which includes a Benchmarks, Indicators and Scoring (BIS) 
tool.
    On December 6, 2017, FICEMS and the Council on Emergency Medical 
Care (CEMC) co-hosted a listening session to hear from stakeholders 
about the challenges facing prehospital trauma care, especially in 
rural settings, and how to better integrate military and civilian EMS 
systems. An integrated national trauma care system would allow lessons 
learned from the battlefield to be translated to civilian EMS and 
provide opportunities for improved patient care.
    A national trauma care system, that integrates military and 
civilian capabilities, is a crucial part of our Nation's infrastructure 
and is vital to preserve the health and productivity of the American 
people.
    The 2016 NASEM report estimates that as many as 20% of the nearly 
200,000 annual trauma deaths in the United States could be prevented. 
In its report, the NASEM defined preventable deaths after injury as 
those casualties whose lives could have been saved by appropriate and 
timely medical care, irrespective of tactical, logistical, or 
environmental issues.

Questions on Improving Prehospital Trauma Care

    Responses to the following questions are requested. Please provide 
references as appropriate.
    1. What are the current impediments, and possible solutions, to 
achieving zero preventable deaths in the following settings:
    a. Wilderness;
    b. Rural;
    c. Suburban; and
    d. Urban.
    2. What should be the national aim for preventable prehospital 
trauma deaths?
    3. What should be the interim national goals to achieve zero 
preventable deaths in the prehospital setting?
    4. What are the most promising or innovative opportunities to 
improve prehospital trauma care in the following settings:
    a. Military;
    b. Wilderness;
    c. Rural;
    d. Suburban; and
    e. Urban.
    5. How could the Learning Health System model (as described in the 
2016 NASEM Trauma Report) be applied to civilian EMS?
    6. Are there actions that could be taken today in the prehospital 
setting (such as promising clinical interventions) that could 
dramatically improve outcomes for patients who are:
    a. Suffering from traumatic pain;
    b. Severely injured in a rural roadway crash;
    c. Suffering from penetrating trauma;
    d. Subjected to a compromised airway;
    e. Suffering from a major hemorrhage;
    f. Suffering from a pneumothorax;
    g. Suffering from blunt force trauma;
    h. Suffering from traumatic brain injury;
    i. Other clinical conditions (please explain).
    7. What EMS evidence based guidelines could be developed to improve 
trauma patient outcomes?
    8. As an EMS stakeholder what do you see is the potential role of 
the National EMS Information System (NEMSIS) and the EMS Compass 
performance measures in improving prehospital trauma care?
    9. How might active duty, National Guard, and reserve component 
military resources be used to improve civilian trauma care outcomes in 
the following settings:
    a. Use of military rotary wing assets to support civilian EMS;
    b. Placement of military medics in the field to support and cross 
train with civilian EMS.

[[Page 18651]]

    10. What actions can be taken to improve public awareness of 
traumatic injury as a public health issue?
    11. What actions could be taken to improve the rapid extrication of 
motor vehicle crash patients?
    12. What actions could be taken to improve the rapid transport of 
trauma patients?
    13. What actions could be taken to improve prehospital care for 
pediatric trauma patients?
    14. What actions could be taken to improve tribal prehospital 
trauma care?
    15. What research is needed to improve prehospital trauma care 
during a mass casualty incident?
    16. What is the potential role of 9-1-1 in improving prehospital 
trauma care outcomes?
    17. What is the potential role of bystander care, such as Stop the 
Bleed, in improving prehospital trauma care outcomes?
    18. What is the potential role of vehicle telematics in improving 
prehospital trauma care outcomes?
    19. What is the potential role of telemedicine in improving 
prehospital trauma care outcomes?
    20. What is the potential role of community paramedicine, mobile 
integrated healthcare, and other emerging EMS subspecialties in 
improving prehospital trauma care outcomes?
    21. How could data-driven and evidence-based improvements in EMS 
systems improve prehospital trauma care?
    22. How could enhanced collaboration among EMS systems, health care 
providers, hospitals, public safety answering points, public health, 
insurers, and others improve prehospital trauma care?
    23. What are some opportunities to improve exchange of evidence 
based prehospital trauma care practices between military and civilian 
medicine?
    24. Do you have any additional comments regarding prehospital 
trauma care?

    Authority: 44 U.S.C. Section 3506(c)(2)(A).

    Issued in Washington, DC, on April 19, 2018.
Jeff Michael,
Associate Administrator, Research and Program Development.
[FR Doc. 2018-08504 Filed 4-26-18; 8:45 am]
 BILLING CODE 4910-59-P