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Beekley and colleagues review lessons drawn from combat casualty care during recent U.S. military operations, emphasizing how large-scale trauma data were collected through the Joint Theater Trauma Registry. The discussion highlights efforts to improve data capture and real-time research, while tracing changes in prehospital triage, resuscitation, and the impact of new devices, dressings, and drugs. 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Beekley, MD* , Benjamin W. Starnes, MD, James A. Sebesta, MD  \nUS Army Medical Corps, Madigan Army Medical Center, 9040 Fitzsimmons Avenue, Fort Lewis, WA 98431, USA  \nThe terrorist attacks of September 11, 2001 on the United States marked the beginning of the ‘‘Global War on Terror.’’ The United States military responded with the first massive deployment of troops from all branches of service since the Persian Gulf War of 1991 . Unlike that conflict, in which prewar casualty estimates far exceeded the actual number of casualties sustained, Operations Iraqi and Enduring Freedom have generated casualties in the largest numbers the United States military has sustained since the Vietnam War. As of June 23, 2006, a total of 18,572 United States military personnel have been wounded in Operation Iraqi Freedom, and another 773 have been wounded in Operation Enduring Freedom. Of these 19,345 casualties, 8975 of them have been wounded seriously enough to warrant evacuation out of the theaters of operations. In addition, 2511 soldiers or Department of Defense civilians have been killed in Operation Iraqi Freedom; 528 of these deaths were from non-hostile causes. An additional 302 personnel have been killed in and around Afghanistan [1] .  \nThe collection of combat casualty data from these operations has resulted in the largest combat trauma database in existence, dubbed the Joint Theater Trauma Registry (JTTR) . Data from deployed medical and surgical units are pooled in a central databank at the United States Army Institute of Surgical Research at Brooke Army Medical Center in San Antonio. These data are currently being linked across three continents so that casualty data from point of injury to ultimate outcome in stateside military  \nThe views expressed in this paper are those of the authors and do not reflect the official policy or position of the Department of the Army, the Department of Defense, or the United States Government.  \n* Corresponding author.  \nE-mail address: [alec.beekley@amedd.army.mil](alec.beekley@amedd.army.mil) (A.C. Beekley) .  \n0039-6109/07/$ - see front matter 􀀂 2006 Elsevier Inc. All rights reserved.  \n[doi:10.1016/j.suc.2006.09.008 surgical.theclinics.com](doi:10.1016/j.suc.2006.09.008 surgical.theclinics.com)  \n158 BEEKLEY et al  \nmedical facilities can be tracked. The logistic, administrative, and technical hurdles involved in this undertaking are obviously enormous, and the process and ease by which individual casualties or groups can be tracked is still somewhat cumbersome. Nevertheless, data analysis and actionable research findings continue to be generated from this extraordinary set of trauma data.  \nThe evolution of a streamlined trauma system in the theaters of operations [2], the introduction of an in-theater institution review board process, and dedicated personnel to collect combat casualty data have resulted in improved data capture and real-time, on-the-scene research (personal communication, John B. Holcomb, MD COL, US Army Medical Corps, 2006) . The result has been the generation of a tremendous body of research on multiple facets of combat casualty care; only a handful of topics are touched on in the current article.  \nThis article first identifies how new or improved devices, dressing, or drugs have impacted prehospital care of casualties, and how prehospital triage guidelines and resuscitation strategies have been changed. The second section focuses on lessons learned at the level of surgical care of combat casualties, and how these concepts are crossing back into civilian practice and training initiatives. The authors conclude with a brief look at the future of combat casualty and, by extension, civilian trauma patient care.  \nPrehospital devices, dressings, and drugs Improved helmets and body armor  \nThere is overwhelming evidence that most survivable war injuries since the beginning of recorded time hav","cbCaip7zbpQGXMLR","https://ap.wps.com/l/cbCaip7zbpQGXMLR","pdf",673047,28,"English","# Lessons learned from modern military surgery\n## Background: combat operations and casualty data\n## Joint Theater Trauma Registry and research workflow\n## Structure of the article: prehospital and surgical lessons\n## Prehospital devices, dressings, and drugs\n## Improved helmets and body armor","[{\"question\":\"What major data source is described for combat trauma research?\",\"answer\":\"The paper describes the Joint Theater Trauma Registry (JTTR), which pools data from deployed medical and surgical units into a central databank.\"},{\"question\":\"How did combat operations increase the availability of trauma research data?\",\"answer\":\"Operations Iraqi Freedom and Enduring Freedom produced large casualty datasets, and efforts to streamline trauma systems and introduce in-theater review processes improved data capture and enabled real-time, on-the-scene research.\"},{\"question\":\"What is the article’s focus regarding prehospital and surgical care?\",\"answer\":\"It first examines how improved devices, dressings, and drugs influenced prehospital care and how triage and resuscitation strategies changed, then covers surgical care lessons and their relevance to civilian practice.\"}]","Lessons Learned from Modern Military Surgery | PDF",1791022233,71]