Military medical revolution: military trauma system.

T development and advancement of trauma care has shown stepwise improvements for centuries owing to the interrelationship of civilian and military medical systems. With respect to trauma systems, the sophisticated civilian trauma system in the United States was born directly out of the successes and lessons learned from the Vietnam War. The American College of Surgeons (ACS) took the lead in advocacy for US trauma systems and, in 1972, published Early Care of the Injured Patient followed in 1976 by the first iteration of the Optimal Resources for Care of the Injured Patient. These documents outlined resources and practices to optimally care for injured patients across the continuum of care within the civilian spectrum. Numerous subsequent studies and analyses demonstrated that inclusive trauma centers and trauma assistance systems improve trauma outcomes. The development of combat casualty care capabilities during the current contingency operations has been a revolutionary story of successful adaptation and evolution, which has driven substantive improvements in the care of the battlefield casualty. This revolution was initiated in 2004 with the inception of a formal military trauma system, the Joint Trauma System (JTS). The purpose of the JTS was to develop a novel systematic and integrated approach to organize and coordinate combat casualty care. The basic principles of the trauma system were founded on four simple tenets: right patient, right place, right time, right care with the guiding vision that every soldier, sailor, airman, and marine injured in the battlefield will have the optimal chances of survival and functional recovery. In 2005, the JTS was originated within the US Army Institute of Surgical Research (USAISR) to support the overarching architecture of the entire continuum of combat casualty care from point of injury through rehabilitation. To support the development of this new military trauma system, a Joint Theater Trauma Registry (JTTR) was developed concurrently and became functional in early 2005. The JTTR captured injury demographics, anatomic and physiologic parameters, and trauma care and outcomes across the continuum of combat casualty care. This registry data provided vital information used to effect improvements in clinical care, drive medically related doctrine and policy, and support the creation of new knowledge through research. The revolutions in military medical affairs (RMMA) relative to the military trauma system are shown in Table 1.