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The National Academies of Sciences, Engineering, and Medicine Report on Zero Preventable Deaths highlighted the need for a military and civilian partnership to take lessons learned from the wars in Iraq and Afghanistan and incorporate them into a national learning trauma care system. One of the specific objectives in the report was to establish military preventable death metrics. Upon further inspection, it became apparent that the Department of Defense did not have an established methodology to reliably estimate and report preventable death metrics and opportunities to improve the military trauma care system. Over the last year, clinical and non-clinical subject matter experts from the Joint Trauma System and Armed Forces Medical Examiners System began the process of establishing a standard military preventable death review process to meet the objective outlined in the report. Based on an assessment to understand methodological best practices for preventable death reviews, this manuscript presents the conceptual framework that is guiding our effort to establish the first ever battle-related mortality surveillance system with preventable death metrics and opportunities to improve the trauma care system. [ABSTRACT FROM AUTHOR]

Wartime vascular injury can be particularly challenging due to the complexity of the case, concomitant injuries, resource limitations, and often lack of expertise of the operating surgeon. The proliferation of vascular shunting has been of particular importance as a damage control surgery technique to restore perfusion and temporize the immediate need for definitive repair necessary for limb salvage, particularly in austere locations. Diagnosis of vascular injury can be made using a variety of techniques, from physical examination to ankle-brachial indices to the use of CT angiography or invasive angiographic techniques. Operative planning and judgment are therefore critical in deciding both how and whether to operate. Surgeons likely to deploy should take every opportunity to practice vascular exposures and techniques through clinical practice and laboratory courses. [ABSTRACT FROM AUTHOR]

The article discusses the joint trauma system and the uncertainty that is the fog of war focusing on developments made in military medicine and rates of mortality due to war casualties. Topics include developments in medical technology, Damage Control Resuscitation, and data collected by trauma registry. Also discussed is the role played by the US Department of defence.

The article article discusses the Joint Trauma System focusing on the history of JTS and efforts made to improve combat casualty care as JTS organizes and coordinates battlefield care to minimize morbidity and mortality and optimize the ability to provide essential care required for casualty injuries. Topics include building of trauma registry for combat casualty care, role played by the US Department of Defense, and Wartime medical system.

Acute respiratory distress syndrome (ARDS) is a condition affecting critically ill patients, characterized by pulmonary inflammation and defects in oxygenation due to either direct or indirect injury to the lungs. These guidelines will define the diagnosis and management of ARDS, particularly among combat casualties and patients in the deployed environment. The cornerstone of management of ARDS involves maintaining adequate oxygenation while avoiding further pulmonary injury through lung-protective ventilation. Additional strategies for advanced respiratory failure, such as prone positioning, neuromuscular blockade, and extracorporeal membrane oxygenation will be reviewed here as well. Particularly important to the care of the patient with ARDS in the deployed environment is a familiarity with the challenges and indications for transport/aeromedical evacuation. [ABSTRACT FROM AUTHOR]

Historically, cold injury, hypothermia, and frostbite have been severe problems for military units on the battlefield. Kenneth D. Orr and David C. Fainer captured these difficulties in their book, Cold Injuries in Korea During Winter of 1950-51, still cited in military medical readiness training. While not common in modern conflicts, the potential exists for large numbers of these casualties in war and during training. [ABSTRACT FROM AUTHOR]

The article discusses Joint Trauma System (JTS) Clinical Practice Guidelines (CPGs) were developed out of necessity to reduce variability in clinical care, improve quality of care, measure outcomes, and weigh the benefits against the risks and costs of specific interventions. Topics include Clinical Practice Guidelines (CPG) compliance, role played by Department of Defense (DoD) trauma cases, and analysis of combat casualty data.

Fractures continue to account for a large proportion of combat-related injuries. The basic tenets of irrigation, debridement, soft tissue care, and vigilant monitoring/fasciotomy for acute compartment syndrome persist. Closed management of fractures with splinting or casting is acceptable. If time and facility allow, external fixation of fractures offer many advantages over closed treatment but require knowledge, experience and skill in the safe placement of pins. The care of host nationals presents unique challenges and deployed surgeons must be flexible and resourceful in these situations. [ABSTRACT FROM AUTHOR]