Trauma system development in a theater of war: Experiences from operation Iraqi freedom and operation enduring freedom

Brian J. Eastridge, Donald Jenkins, Stephen Flaherty, Henry Schiller, John B. Holcomb

Research output: Contribution to journalArticlepeer-review

205 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)1366-1372
Number of pages7
JournalJournal of Trauma - Injury, Infection and Critical Care
Issue number6
StatePublished - Dec 2006
Externally publishedYes


  • Battlefield
  • Combat
  • Quality improvement
  • System
  • Trauma
  • War

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine


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