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From FOB to PICU: military trauma systems that changed pediatrics
Sara Bibbens1, Matthew Borgman2
1Assistant Professor, Department of Pediatrics, Uniformed Services University, Bethesda, MD, USA.
Insights
Military trauma care innovations, including tourniquet use and balanced transfusions, significantly improve civilian pediatric mass-casualty incident (MCI) preparedness and response. These combat-tested strategies enhance pediatric trauma resuscitation and disaster management.
Area of Science:
- Military medicine
- Trauma surgery
- Pediatric emergency care
Background:
- The U.S. Department of Defense Joint Trauma System (JTS) has driven advancements in battlefield trauma care.
- Over two decades of pediatric wartime casualty data from Iraq and Afghanistan offer critical insights.
- Military lessons learned are increasingly influencing civilian pediatric trauma and disaster response protocols.
Purpose of the Study:
- To examine the historical evolution of military trauma systems.
- To evaluate the effectiveness of Critical Care Air Transport Teams (CCATT).
- To analyze the translation of Combat Casualty Care (CCC) principles into civilian pediatric practice.
Main Methods:
- Historical review of military trauma system development.
- Analysis of CCATT operational data.
- Case studies on the implementation of CCC principles in civilian settings.
Main Results:
- Military trauma systems have demonstrably improved battlefield care through data-driven performance enhancement.
- CCC principles, including tourniquet application, tranexamic acid (TXA), and balanced transfusion protocols, have been successfully adapted for civilian pediatric use.
- These military-derived innovations enhance pediatric preparedness, resuscitation, and disaster response.
Conclusions:
- Military trauma care frameworks provide a robust foundation for improving civilian pediatric mass-casualty incident management.
- The integration of combat-tested strategies enhances the resilience and effectiveness of pediatric trauma systems.
- Continuous adaptation of military medical lessons learned is vital for advancing pediatric emergency and disaster care.
Abstract:
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.
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