Establishing an Enduring Military Trauma Mortality Review: Misconceptions and Lessons Learned.

Under direction from the Defense Health Agency, subject matter experts from the Joint Trauma System, Armed Forces Medical Examiner System, and civilian sector established the Military Trauma Mortality Review process. In order to establish the most empirically robust process, these subject matter experts employed both qualitative and quantitative methods published in a series of peer-reviewed manuscripts over the last three years. Most recently, the Military Mortality Review process was implemented for the first time on all battle injured service members attached to the United States Special Operations Command from 2001-2018. The current Military Mortality Review process builds on the strengths and limitations of important previous work from both the military and civilian sector. To prospectively improve the trauma care system and drive preventable death to the lowest level possible, we present the main misconceptions and lessons learned from our three-year effort to establish a reliable and sustainable Military Trauma Mortality Review process. These lessons include the following: (1) requirement to use of standardized and appropriate lexicon, definitions, and criteria; (2) requirement to use a combination of objective injury scoring systems, forensic information, and thorough subject matter expert case review to make injury survivability and death preventability determinations; (3) requirement to use non-medical information to make reliable death preventability determinations and a comprehensive list of opportunities for improvement to reduce preventable deaths within the trauma care system; and (4) acknowledgement that the military health system still has gaps in current infrastructure that must be addressed to globally and continuously implement the process outlined in the Military Trauma Mortality Review process in the future.