Baker Jay B, Keenan Sean, Duquette-Frame Teresa A, Kotwal Russ, Harvey Andrew S, Cap Andrew P, Shackelford Stacy A, Gurney Jennifer M
Joint Trauma System, Defense Health Agency, JBSA Fort Sam Houston, TX 78234, USA.
Department of Distance Education, Command and General Staff School, Fort Leavenworth, KS 66027, USA.
Mil Med. 2024 May 18;189(5-6):1098-1105. doi: 10.1093/milmed/usad053.
In recent conflicts, the Joint Theater Trauma System (JTTS) led the systematic approach to improve battlefield trauma care, substantially contributing to the unprecedented survival of combat casualties. The Joint Trauma System (JTS) was codified in 2016 to preserve the lessons learned and functions of the JTTS, including the Department of Defense Trauma Registry. Concurrently, Combatant Commands (CCMD) were directed to establish CCMD Trauma Systems (CTS) "modeled after the JTTS" and to maintain a baseline of core functions intended to rapidly scale as needed. The complex nature of both CCMDs and the military trauma system has challenged the full implementation of the CTS. Analyzing the historical experiences of the JTTS, JTS, and CTS within a military doctrinal framework might enable the further success of the military trauma system.
The strategic, operational, and tactical levels of warfare, in accordance with Joint Publication 1-0, Doctrine of the Armed Forces of the United States, and Joint Publication 3-0, Joint Operations, established the analytic framework for this study. The literature regarding the JTTS, CTS, and JTS was reviewed for relevant information concerning organizational structure and functions of trauma system performance improvement (PI) capabilities. A comprehensive analysis was performed using a thematic approach to evaluating descriptive data contained within the collected data set. Deployed trauma system PI tasks, functions, and responsibilities were identified, defined, and correlated according to the respective levels of warfare.
The comprehensive analysis revealed both discrete and overlapping tasks, functions, and responsibilities of the trauma system PI capabilities at each of the three levels of warfare. Strategic-level actions were categorized according to 12 distinct themes: reduce mortality; strategic reporting; centralized trauma registry; strategic communications; centralized organization; direct support to CCMDs; Department of Defense policy and doctrine; strategic-level PI; clinical practice guidelines; training and readiness standards; force structure, standardization, and interoperability; and research and development. Operational-level actions were categorized according to seven distinct themes: theater trauma system policies and requirements; theater trauma system leadership; stakeholder coordination; theater communication; theater standards for readiness and skill sustainment; trauma system planning; and medical logistics support. Tactical-level actions were categorized according to seven distinct themes: trauma system personnel; PI; documentation enforcement and patient care data collection; tactical planning recommendations for employing medical assets; research support; communication and reporting; and training and skills sustainment.
The deployed U.S. military trauma system requires a robust PI capability to optimize combat casualty care. Policy updates, a joint military trauma system doctrine, and force design updates are necessary for deployed military trauma system PI capabilities to function optimally across all levels of warfare.
在最近的冲突中，联合战区创伤系统（JTTS）引领了改善战场创伤护理的系统方法，为战斗伤亡人员前所未有的存活率做出了重大贡献。联合创伤系统（JTS）于2016年编纂，以保留从JTTS吸取的经验教训和功能，包括国防部创伤登记处。与此同时，作战司令部（CCMD）被指示建立“以JTTS为蓝本”的CCMD创伤系统（CTS），并维持旨在根据需要迅速扩展的核心功能基线。CCMD和军事创伤系统的复杂性对CTS的全面实施构成了挑战。在军事理论框架内分析JTTS、JTS和CTS的历史经验，可能会推动军事创伤系统取得更大成功。
根据美国武装部队理论联合出版物1-0《美国武装部队理论》和联合出版物3-0《联合作战》，战争的战略、作战和战术层面为这项研究建立了分析框架。查阅了关于JTTS、CTS和JTS的文献，以获取有关创伤系统绩效改进（PI）能力的组织结构和功能的相关信息。使用主题方法对收集的数据集中包含的描述性数据进行了全面分析。根据战争的各个层面，确定、定义并关联了已部署的创伤系统PI任务、功能和职责。
全面分析揭示了创伤系统PI能力在战争三个层面各自的离散和重叠任务、功能及职责。战略层面的行动根据12个不同主题进行分类：降低死亡率；战略报告；集中式创伤登记处；战略通信；集中式组织；对CCMD的直接支持；国防部政策和理论；战略层面的PI；临床实践指南；培训和战备标准；部队结构、标准化和互操作性；以及研发。作战层面的行动根据7个不同主题进行分类：战区创伤系统政策和要求；战区创伤系统领导；利益相关者协调；战区通信；战区战备和技能维持标准；创伤系统规划；以及医疗后勤支持。战术层面的行动根据7个不同主题进行分类：创伤系统人员；PI；文件执行和患者护理数据收集；使用医疗资产的战术规划建议；研究支持；通信和报告；以及培训和技能维持。
已部署的美国军事创伤系统需要强大的PI能力来优化战斗伤亡护理。政策更新、联合军事创伤系统理论以及部队设计更新对于已部署的军事创伤系统PI能力在战争的所有层面上实现最佳运作是必要的。
