From FOB to PICU: military trauma systems that changed pediatrics

The U.S. Department of Defense Joint Trauma System (JTS) has transformed battlefield trauma care through data-driven performance improvement, standardized guidelines, and continuous feedback. Lessons learned from pediatric wartime casualties in Iraq and Afghanistan, spanning more than two decades, have extended beyond combat, influencing how civilian pediatric trauma and disaster systems prepare for and manage mass-casualty incidents (MCIs). This manuscript examines the historical development of military trauma systems, the evaluation of Critical Care Air Transport Teams (CCATT), and the translation of Combat Casualty Care (CCC) principles, such as tourniquet use, tranexamic acid (TXA), and balanced transfusion, into civilian pediatric practice. These innovations demonstrate how military-derived frameworks continue to shape pediatric preparedness, trauma resuscitation, and disaster response across both prehospital and hospital domains.