Our History• Origins in San Antonio, starting in 2003 due to presence of 3

Level 1 Trauma Centers (2 DOD) and long standing culture of civilian/military collaboration

• Formal partnership of USAISR, BAMC, WHMC and UTHSCSA/UHS, original agreement signed by then current commanders, MG James K. Gilman and Maj. Gen. Bruce Green

• Focus on research, education, clinical care• Decision to become a national organization to address the

much larger problem with solutions• Established NTI as a 501 (c) 3 organization in 2006

The National Problem•Lack of centralized, organized infrastructure to guide the direction of study and dispersal of research funding•Research topics are unfocused•Multicenter trials are very few and underfunded, but are critical•Many studies that require a multicenter approach are done as single-center studies, without cohesive use of funds and resources•Battlefield innovations are not transferred to the civilian setting

2007 Institute of Medicine Recommendation

“The Secretary of the Department of Health and Human Services should conduct a study to examine the gaps and opportunities in emergency and trauma care research….this study should include consideration of training of new investigators, development of multicenter research networks, funding of General Clinical Research Centers…involvement of emergency and trauma care researchers in the grant review and research advisory processes, and improved coordination through a dedicated center or institute.”

Our Solution

• Work with Congress and health care agencies to advocate for financial support of a national center to coordinate and fund trauma research

• Set national trauma research priorities and agenda• Engage with wide range of researchers across the

U.S. including military research community• Encourage growth in trauma research community• Provide forum for dissemination of research

outcomes to the trauma community

NTI Mission

To reduce injury, death, and disability by:• Elevating trauma on the national research

agenda;• Generating funds and awarding research grants

for near-term translational research projects to increase scientific knowledge related to trauma, burns, and injury prevention; and

• Changing clinical practice throughout the nation

NTI Vision

• To stop unnecessary suffering from trauma through prevention, education, and research

• Ultimately to decrease rates of death and disability in trauma patients

• To be recognized as a major grant making institution for translational trauma research

Represented on the Board

• American Association for the Surgery of Trauma• American College of Surgeons/Committee on Trauma• EAST (Eastern Association for Surgery of Trauma)• Western Trauma Association• American College of Emergency Physicians• Shock Society• Journal of Trauma• Orthopedic Trauma Association• American Association of Neurological Surgeons• USAISR• US Army• US Navy• US Air Force

Advantage: Expertise•Board members have wealth of knowledge about past and current research, successes vs. failures, strength of investigator community•Science Committee provides strong peer-review process for all submissions; all members review all proposals

Advantage: Leadership

• All Board members are serving or have served as leaders in national trauma organizations

• All voluntary leadership • Includes academic organizations and military

experience• Bylaws require representatives from all

relevant academic and professional societies, and from the Army, Air Force and Navy

Advantage: Efficiency•Speed and ability to streamline the process for investigators•Experience with the funding process, contract management and compliance•History of working with USAISR and TATRC at many levels on different projects

Funds Management Experience

•Previous experience managing $5.2 million in federal funds over 3 years, resulting in 23 abstracts, 24 presentations, 17 publications•Generated and managed $3.8 million in Texas Emerging Technology Funds for Wireless Vital Signs Monitor•Requested/received $7.5 million in Congressional Appropriations:

FY08 $1.6 millionFY09 $2.1 millionFY10 $3.8 million

NTI Science Committee

Science Committee Members

M. Margaret Knudson, MD, ChairDavid B. Hoyt, MD, Vice-ChairTimothy C. Fabian, MDDonald H. Jenkins, MDGregory J. Jurkovich, MDEllen J. MacKenzie, PhDAndrew B. Peitzman, MDBasil A. Pruitt, Jr., MDRonald M. Stewart, MD

RESEARCH PRIORITIES

Determined with input from military and civilian leaders in trauma surgery:– Hemorrhage Management– Airway & Ventilation Strategies– Technology Development– Disaster Preparedness– Infection Control– Burn Treatment

What We Do

• Science Committee determines priorities for each RFP, which is then broadly distributed

• Pre-proposals are reviewed by Science Committee; invitations are issued for full proposals

• Science Committee evaluates proposals, makes proposal selections, and recommends awards and funding decisions to the Board

• The Board considers recommendations and has ultimate approval and includes representatives of Army, Air Force, Navy

What We Do

• For each study NTI manages compliance through TATRC, HRPO, and USAMRMC, then issues contracts

• NTI prepares scientific reports and funds disbursements to awardees

• NTI requires and manages annual, face-to-face meeting of awarded investigators

• NTI holds annual trauma symposium to disseminate results and provide education to multidisciplinary military/civilian trauma providers

Review Criteria•Scientific merit•Clinical relevance•Clinical impact•Innovation•Feasibility of completing study on time•Military relevance•Appropriate budget•Potential for follow-on studies•Multicenter involvement

Proposals and Awards

• January, 2010–85 pre-proposals from 25 states plus DC–15 invitations for full proposals–7 awarded studies, with 22 participating sites

• January, 2011–92 pre-proposals from 25 states–21 invitations for full proposals–8 awarded studies, with 20 participating sites

FY08/09 Lead Sites Participating FY10 Lead Sites Participating

Award Distribution

1st Request for Proposals$1.4 million in Awards

• Mycoplasma Pneumoniae in the ICU—University of Texas Health Science Center at San Antonio, Dr. Joel Baseman, PI

• Timing and Mechanism of Traumatic Coagulopathy—University of California at San Francisco, Dr. Mitchell Cohen, PI

• Evaluation of Ventilator Bundle in Injured Patients—University of Tennessee Health Science Center at Memphis, Dr. Martin Croce, PI

• Comparative Effectiveness of Clinical Care Processes in Resuscitation and Management of Moderate to Severe Traumatic Injuries—Baylor Research Institute, Dr. Shahid Shafi, PI

• Comparison of IV Iron Supplementation to both Enteral Supplementation and Placebo for the Anemia of Traumatic Critical Illness—University of Colorado at Denver, Dr. Fred Pieracci, PI

• Vasopressin Supplementation during Resuscitation of Hemorrhagic Shock—University of Pennsylvania, Dr. Carrie Sims, PI

• Characterization of the effects of the early Sex-Hormone Environment Following Injury—University of Pittsburgh, Dr. Jason Sperry, PI

2ND Request for Proposals$2.8 million in Awards

• Specific research questions included:– Control of non-compressible hemorrhage– Effective resuscitation strategies– New treatments for shock– Understanding the coagulopathy of trauma– The elimination of hospital acquired infections– Airway and ventilation management strategies– Challenges in battlefield and pre-hospital care and

communication

NTI Strategies

• Develop and support a Trauma Clinical Trials Network• Seek permanent federal funding • Generate private funds/philanthropy• Expand Science Committee• Provide training and development of the next

generation of trauma researchers• Disseminate results to effect changes in clinical practice• Provide the “evidence” in evidence-based trauma care