Predicting Interoperability: A Retrospective Comparison of Combat Casualty Care Delivered to French and U.S....

Based on data from the U.S. Department of Defense Joint Trauma Registry, the Joint Trauma System has developed clinical practice guidelines for combat casualty care (CCC). As future high-intensity conflicts are likely to involve multinational operations, interoperability with allied nations-whose trauma systems may differ from established U.S. practices-is essential. This study aimed to compare key characteristics of French and U.S. military trauma systems to anticipate interoperability in CCC.

This retrospective observational study included all U.S. and French service members (SMs) who sustained a severe battle injury requiring intensive care unit admission between 2009 and 2022. Demographics, prehospital management, and in-hospital interventions, including transfusions and tranexamic acid administration, were analyzed.

A total of 734 U.S. and 98 French SMs met inclusion criteria. Most U.S. casualties occurred in Afghanistan (96.3%), whereas French casualties were mainly engaged in Africa after 2013 (51.0%). U.S. SMs sustained more improvised explosive device-related injuries (54.3% vs. 33.7%, P < .001) and fewer penetrating injuries (68.1% vs. 84.7%, P < .001) than French SMs. French SMs were more frequently managed by a prehospital physician (80.6% vs. 53.1%), received more prehospital transfusions (16.3% vs. 7.9%, P = .005), and more tranexamic acid (28.6% vs. 7.9%, P < .001). Median transport time from point of injury to surgical care was longer for French SMs (120 vs. 50 minutes).

Both trauma systems emphasize early prehospital transfusion. Key differences include mechanisms of injury, the presence of a physician in prehospital teams, early tranexamic acid use, and evacuation timelines. Enhancing interoperability will require strengthened international data sharing, harmonization of competencies, and sustained collaboration in CCC.