MSSP454: GLOBAL MILITARY AND CIVILIAN TRAUMA SYSTEMS INTEGRATION: BARRIERS AND FACILITATORS TO SUCCESS
Matthew Arnaouti, MBBS MA1; Captain Michael Baird, MD1; Captain Ghassan Al Swaiti, MD2; Lieutenant Colonel Amila Ratnayake, MS3; Commander Tamara Worlton, MD4; Michelle Joseph, MBBS PhD1; 1Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA; 2Department of Plastic and Reconstructive Surgery, Royal Rehabilitation Center of the Royal Medical Services, King Hussein Medical Center, Amman, Jordan; 3Department of Surgery, Army Hospital Colombo, Colombo, Sri Lanka; 4Department of Surgery, Uniformed Services University, Bethesda, MD
Objectives: The current context of global health places traumatic injury as a principal issue. Military medicine has played an integral role in advancing trauma care worldwide - with widespread recognition of the substantial benefits that may be gained from utilising a collaborative approach to civilian and military organisations. However, civilian-military partnerships that are focused on improving trauma care delivery, currently lack reproducible processes - inhibiting sustainability and efficacy. This study was conducted to develop an understanding of the complex interactions between military and civilian healthcare systems during collaborative efforts - specifically highlighting the barriers to, and facilitators of, successful civilian-military partnerships.
Methods: Eight case studies evidencing successful civilian-military partnerships were obtained through convenience sampling. These instances consisted of five national (Israel, Jordan, Peru, Sri-Lanka, the United States) and three international (South Africa-Netherlands, United Arab Emirates-United States, United Kingdom-Pakistan) examples. Qualitative assessment was then conducted, focusing on seven core domains: ‘Examples of Integration’, ‘Demographic Information’, ‘Relevant Historical Context’, ‘Reasons for Integration Occuring’, ‘Methodology and Rationale of Processes’, ‘Lessons Learned’, and finally ‘Future Development Potential’. The process was iterative, and emerging themes were documented throughout the analytic process. Further thematic qualitative and quantitative analysis of the data obtained is ongoing - this will be complete by December 2021.
Results: Case studies were conducted within/between Israel, Jordan, the Netherlands, Peru, Pakistan, UAE, the United States, the United Kingdom, South Africa and Sri Lanka. Significant variation is noted between these nations, in their training, treatment, and care delivery of trauma patients. The nature of these partnerships were also diverse - including in how they were undertaken, how they succeeded, and how they can be improved. The focus of this study is to highlight barriers and facilitators to future collaborative partnerships. Notable barriers consist of security concerns, cultural discordance, historical antagonism between military and civilian sectors, and geography. Important facilitators included sufficient senior-level support (governmental and military), patriotic environments, skill sustainment/development, financial benefit, and also geography.
Conclusion: Through analysing successful civilian-military partnerships, an understanding of the required methodological processes has been gained. The key information highlighted in this study has substantial potential to inform the development of best practices in the future. This should serve as the foundation, upon which a framework to guide ongoing civilian-military collaboration, can be developed. The resultant framework will enhance collaboration, improve interoperability, and optimise resource allocation - ultimately aiming to improve the quality of trauma care provided globally.