The majority of injury research in the U.S. is paid for by the federal government. However, the government’s process for funding trauma research is unclear to many physicians and scientists. Recently, representatives from the National Institutes of Health (NIH) and the Department of Defense (DoD) discussed the government’s approach to backing research on traumatic injury. They also offered insights on how trauma researchers can increase their chances of securing federal support.
The discussion took place during a January 29 virtual seminar hosted by the Indiana University School of Medicine (IUSM). The title of the panel discussion was “The Trauma Care Research Landscape in the Federal Government: Priorities, Challenges, and New Directions.”
Featured speakers at the event were Jeremy Brown, MD, director of the Office of Emergency Care Research (OECR) at the NIH, and Commander Travis Polk, MD, FACS, director of the DoD’s Combat Casualty Care Research Program (CCCRP).
Dr. Brown and Commander Polk described their programs, discussed the state of the science in prehospital and trauma care, and identified emerging priorities in multidisciplinary trauma research. They noted that there is a widening gap between the research priorities of the NIH and the DoD, making it essential for investigators to understand the goals of each agency and develop proposals to match.
NIH trauma proposals must target individual institutes
Dr. Brown explained that trauma researchers seeking funding from the NIH face several obstacles.
First, no single institute or center at the NIH has responsibility for trauma research. As a result, a researcher seeking funding to study complex injuries or care issues may fail to find a clear “home” for a grant submission. This translates to limited funding for such research.
Second, most of the NIH institutes and centers are organized around a disease (such as cancer or substance use disorders), an organ system (such as the heart or brain) or a population (such as children or the elderly). Since trauma is population-agnostic and often impacts multiple organ systems simultaneously, many trauma research studies do not fit neatly into the NIH system.
For those seeking NIH funding for trauma research, the implication is that proposals should directly address the mission of one of the institutes or centers within the NIH. For example:
- Research on traumatic brain injury might be targeted to the National Institute of Neurological Diseases and Stroke (NINDS).
- A study examining vascular injury after hemorrhage might be directed toward the National Heart, Lung, and Blood Institute (NHLBI).
- A proposal to elucidate the mechanisms of immune dysregulation after traumatic injury might have the best chance at the National Institute of General Medical Sciences (NIGMS).
The OECR itself plays predominantly a coordinating role, and it is a valuable resource for trauma researchers. Dr. Brown works with many of the 27 NIH institutes and centers to promote trauma-related research topics.
DoD injury research shifting to “battlefield of the future”
Commander Polk explained that the DoD tends to take a more holistic view of trauma and emergency care than the NIH. Defense trauma research focuses on patient needs from the point of injury through definitive care.
However, he noted that the military’s focus with regard to trauma care is shifting. In many ways, this shift is driving military research priorities further away from civilian trauma research needs.
According to Commander Polk, the driver of research priorities at the CCCRP is the “battlefield of the future.” Under this paradigm, it is envisioned that U.S. forces will be fighting adversaries who are as sophisticated and as well-equipped as they are. In this environment, U.S. forces may lack the air superiority required to evacuate casualties promptly.
Consequently, future combat casualty care needs are now thought about in terms of prolonged field care — emergency, surgical and critical care delivered in place for as long as 72 hours or more.
The implication for trauma researchers: Proposals that directly address these military priorities — generally speaking, point of injury care with delayed evacuation to surgical care — will be more competitive with the DoD. According to Commander Polk, key areas of current focus include:
- Non-compressible hemorrhage control
- Advanced blood products and bioengineered blood surrogates
- Semi-autonomous systems for vascular access, airway access, chest decompression and imaging
- Decision support tools that leverage artificial intelligence and machine learning
- Autonomous medical evacuation
Venue for thought leaders in trauma
The Coalition for the Advancement of Research and Innovation in Trauma (CARIT) assisted Indiana University, a CARIT member organization, in organizing and hosting this event. This seminar is one of several recent efforts to provide military and civilian thought leaders a venue for sharing knowledge, stimulating innovative ideas, and networking to improve trauma and emergency care research and education.
The 90-minute seminar began with opening remarks by Tatiana Foroud, PhD, executive associate dean for research affairs at IUSM. Todd McKinley, MD, professor of orthopaedic surgery at IUSM and a CARIT board member, introduced the speakers and moderated the discussion focused on questions posed by attendees.
Ross Donaldson, MD, MPH, president and CEO of Critical Innovations, LLC, and associate professor of emergency medicine at the University of California Los Angeles (UCLA) School of Medicine, joined the panel discussion and provided insight into the role of federal funding in making sure trauma innovation reaches the bedside.
David Baer, PhD, is chair of the Coalition for the Advancement of Research and Innovation in Trauma (CARIT), an independent alliance of industry, academic and research institutions, clinicians and other organizations that are working together to incentivize research and innovation and augment R&D funding for unmet needs in trauma, emergency and pre-hospital care. Visit www.caritrauma.com.