title: Trauma system development in a theater of war: Experiences from Operation Iraqi Freedom and Operation Enduring Freedom.
abstract: BACKGROUND
  Medical lessons learned from Vietnam and previous military conflicts led to the development of civilian trauma systems in the United States. Operation Iraqi Freedom represents the first protracted, large-scale, armed conflict since the advent of civilian trauma systems in which to evaluate a similar paradigm on the battlefield.
  
  
  METHODS
  Collaborative efforts between the joint military forces of the United States initiated development of a theater trauma system in May 2004. Formal implementation of the system occurred in November 2004, the collaborative effort of the three Surgeons General of the U.S. military, the United States Army Institute of Surgical Research, and the American College of Surgeons Committee on Trauma. One trauma surgeon (Trauma System Director) and a team of six trauma nurse coordinators were deployed to theater to evaluate trauma system component issues. Demographic, mechanistic, physiologic, diagnostic, therapeutic, and outcome data were gathered for 4,700 injured patients using the Joint Theater Trauma Registry. Interview and survey methods were utilized to evaluate logistic aspects of the system.
  
  
  RESULTS
  System implementation identified more than 30 systemic issues requiring policy development, research, education, evaluation of medical resource allocation, and alterations in clinical care. Among the issues were transfer of casualties from point of injury to the most appropriate level of care, trauma clinical practice guidelines, standard forms, prophylactic antibiotic regimens, morbidity/mortality reporting, on-line medical evacuation regulation, improved data capture for the trauma registry, and implementation of a performance improvement program.
  
  
  CONCLUSIONS
  The implementation of a theater trauma system demonstrated numerous opportunities to improve the outcome of soldiers wounded on the battlefield.
authors.affiliation: Brooke Army Medical Center, Department of Surgery, US Army Institute for Surgical Research, San Antonio, Texas 78234, USA. brian.eastridge@amedd.army.mil
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Eastridge
authors.forename: Donald
authors.initials: D
authors.lastname: Jenkins
authors.forename: Stephen
authors.initials: S
authors.lastname: Flaherty
authors.forename: Henry
authors.initials: H
authors.lastname: Schiller
authors.forename: John B
authors.initials: JB
authors.lastname: Holcomb
mesh_terms: D006775:Hospitals, Packaged / Q000458:organization & administration*; D006801:Humans; D007493:Iraq; D008887:Military Medicine; D017410:Practice Guidelines as Topic; D016730:Program Development; D014187:Transportation of Patients / Q000458:organization & administration; D014193:Trauma Centers / Q000458:organization & administration*; D014218:Triage / Q000458:organization & administration; D014481:United States; D014857:Warfare; D014947:Wounds and Injuries / Q000628:therapy*