Integrating military trauma care with traditional hospitals could lead to a quicker and more effective response to car accidents, gunshot wounds and other trauma events, according to a new report from the National Academies of Sciences, Engineering, and Medicine.

Trauma is the leading cause of death in the U.S. for people under the age of 46. The report said about 30,000 of the nearly 148,000 trauma deaths in 2014 could have been prevented with optimal trauma care.

The committee who authored the report said the location of an accident relative to a trauma center shouldn’t be a factor in whether someone survives. The shooting that left 49 people dead at the Pulse Nightclub in Orlando happened just blocks away from a major trauma center, which the Associated Press argues undoubtedly saved lives.

“The shadow of Orlando is on everything we’re doing today. Everything we’re learning about injuries in the battlefield has a lot to do with our preparedness and ability to respond to mass casualties,” said Donald Berwick, MD, chair of the NAS committee and senior fellow at the Institute for Healthcare Improvement.

The key to improving trauma care, the committee said, is to have the White House lead the development of a national trauma care system using lessons the military has learned. The number of wounded service members who died of traumatic injuries in Afghanistan decreased by 50 percent between 2005 and 2013, and Berwick said given its success in reducing trauma deaths, battlefield practices should be applied to care for civilians.

“Even as the successes have saved many lives, the disparities have cost many lives,” Berwick said. “With the decrease in combat and the need to maintain readiness for trauma care between wars, a window of opportunity now exists to integrate military and civilian trauma systems and view them not separately, but as one.” 

Such an approach will require coordination and policy changes. For example, there is no federal agency dedicated to trauma care, which is why the committee urged the White House to get involved, along with cooperation between HHS and the Department of Defense.

The committee’s recommendations also included changing how emergency medical services (EMS) are classified by healthcare organizations and federal agencies. Rather than CMS reimbursing ambulance services as a transporter to medical facilities, the committee called for them to be treated as a health care provider. To integrate EMS into the health care system, the report recommended several actions which would need congressional approval, like modifying the ambulance fee schedule in CMS, moving away from the current fee-for-transport model.