title: Evolution of biomedical research during combat operations.
abstract: BACKGROUND
  The implementation of a human research protection program in Afghanistan and the mobilization of the combat casualty research team have made it possible to design and efficiently conduct multifaceted, multisite, and prospective research studies in a combat environment. Still, to conduct research in such an environment, several unique challenges must be overcome.
  
  
  METHODS
  This article describes the development and conduct of three ongoing trauma-related biomedical research studies in Afghanistan, highlighting the challenges and lessons learned within the context of these studies.
  
  
  RESULTS
  Key challenges include the process of developing and getting approval for in-theater research protocols, the informed consent process, and logistics of conducting a biomedical research study in an austere environment. Despite these challenges, important lessons learned that can contribute to the success of a protocol include the need for clear operating procedures, judicious selection for which data points must be collected in-theater, and the importance anticipating the "fog and friction" of war.
  
  
  CONCLUSIONS
  As we continue the journey toward more sophisticated research capabilities in combat, this article will help inform the design and conduct of future research performed in a theater of war. Conducting biomedical research in a combat zone is an important but difficult element of military medicine.
authors.affiliation: David Grant Medical Center, Travis Air Force Base, California, USA. jennifer.hatzfeld@gmail.com
authors.forename: Jennifer J
authors.initials: JJ
authors.lastname: Hatzfeld
authors.forename: John D
authors.initials: JD
authors.lastname: Childs
authors.forename: Michael P
authors.initials: MP
authors.lastname: Dempsey
authors.forename: Gail D
authors.initials: GD
authors.lastname: Chapman
authors.forename: Jurandir J
authors.initials: JJ
authors.lastname: Dalle Lucca
authors.forename: Teresa
authors.initials: T
authors.lastname: Brininger
authors.forename: Cindy
authors.initials: C
authors.lastname: Tamminga
authors.forename: Roxanne T
authors.initials: RT
authors.lastname: Richardson
authors.forename: Stefan
authors.initials: S
authors.lastname: Alexander
authors.forename: Kevin K
authors.initials: KK
authors.lastname: Chung
mesh_terms: D055826:Afghan Campaign 2001-; D035843:Biomedical Research / Q000379:methods* / Q000458:organization & administration; D006801:Humans; D007258:Informed Consent; D008887:Military Medicine / Q000379:methods* / Q000458:organization & administration; D014481:United States; D014947:Wounds and Injuries / Q000601:surgery / Q000628:therapy