title: Establishing a Joint Theater Trauma System During Phase Zero Operations.
abstract: Military personnel risk injury due to accidents, disasters, and military threats during Phase Zero "shaping" operations. Medical facilities must be poised to respond.
  
  
  
  The U.S. Pacific Command (PACOM) Area of Responsibility (AOR) covers more than 50% of the earth's surface; relevant Clinical Practice Guidelines must include the maritime setting and extended evacuation periods. Military hospitals in the region are not connected by a defined Trauma System. There is variable adherence to trauma training requirements before assignment in this AOR. Demand for trauma care at any 1 location is low and trauma teams have little opportunity to maintain competency for high-risk/low-volume interventions. There is no documentation of total demand for trauma care in the AOR. Trauma care in PACOM is often deferred to civilian facilities.
  
  
  
  Core elements of a Joint Theater Trauma System (JTTS) as established during combat operations in U.S. Central Command are applicable during Phase Zero. A PACOM JTTS was established to address the region's readiness to respond to Phase Zero trauma as well as escalation of regional threats. Information technology coordination was a critical hurdle to overcome.
  
  
  
  PACOM lessons learned are applicable to other Geographic Combatant Commands developing a JTTS during Phase Zero operations.
authors.affiliation: Graduate Medical Education, Womack Army Medical Center, 2817 Reilly Road, Fort Bragg, NC 28310.
authors.forename: Jennifer J
authors.initials: JJ
authors.lastname: Walker
authors.affiliation: Joint Trauma System, 3698 Chambers Pass, Suite B, U.S. Army Institute of Surgical Research, Fort Sam Houston, TX 78234.
authors.forename: Zsolt T
authors.initials: ZT
authors.lastname: Stockinger
authors.affiliation: Research, Development and Acquisition, Defense Health Agency, 7700 Arlington Boulevard, Suite 5101, Falls Church, VA 22042.
authors.forename: Colin G
authors.initials: CG
authors.lastname: Chinn
mesh_terms: D003299:Cooperative Behavior; D006772:Hospitals, Military / Q000458:organization & administration / Q000639:trends*; D006801:Humans; D008887:Military Medicine / Q000379:methods* / Q000639:trends; D010140:Pacific Ocean / Q000453:epidemiology; D013997:Time Factors; D014857:Warfare; D014947:Wounds and Injuries / Q000453:epidemiology