Military trauma training at civilian centers: A decade of advancements Chad M. Thorson, MD, MSPH, Joseph J. Dubose, MD, Peter Rhee, MD, Thomas E. Knuth, MD, Warren C. Dorlac, MD, Jeffrey A. Bailey, MD, George D. Garcia, MD, Mark L. Ryan, MD, Robert M. Van Haren, MD, and Kenneth G. Proctor, PhD ABSTRACT: In the late 1990s, a Department of Defense subcommittee screened more than 100 civilian trauma centers according to the number of admissions, percentage of penetrating trauma, and institutional interest in relation to the specific training missions of each of the three service branches. By the end of 2001, the Army started a program at University of Miami/Ryder Trauma Center, the Navy began a similar program at University of Southern California/Los Angeles County Medical Center, and the Air Force initiated three Centers for the Sustainment of Trauma and Readiness Skills (C-STARS) at busy academic medical centers: R. Adams Cowley Shock Trauma Center at the University of Maryland (C-STARS Baltimore), Saint Louis University (C-STARS St. Louis), and The University Hospital/ University of Cincinnati (C-STARS Cincinnati). Each center focuses on three key areas, didactic training, state-of-the-art simulation and expeditionary equipment training, as well as actual clinical experience in the acute management of trauma patients. Each is integral to delivering lifesaving combat casualty care in theater. Initially, there were growing pains and the struggle to develop an effective cur- riculum in a short period. With the foresight of each trauma training center director and a dynamic exchange of information with civilian trauma leaders and frontline war fighters, there has been a continuous evolution and improvement of each center’s curriculum. Now, it is clear that the longest military conflict in US history and the first of the 21st century has led to numerous innovations in cutting edge trauma training on a comprehensive array of topics. This report provides an overview of the decade-long evolutionary process in providing the highest-quality medical care for our injured heroes. (J Trauma Acute Care Surg. 2012;73: S483YS489. Copyright * 2012 by Lippincott Williams & Wilkins) KEY WORDS: Army; Navy; Air Force; combat casualty care; trauma training. T hroughout history, many of the greatest innovations in medicine and surgery have originated during short periods of intense warfare rather than during longer intervening peri- ods of peace. Thus, it is not surprising that many current military medical doctrines can be traced to two brief battles in the 1990s. The first was Operation Desert Storm (January 17 to February 28, 1991), which was waged by a US-led coalition force against Iraq in response to the invasion and annexation of Kuwait. The second was the Battle of Mogadishu (October 3Y4, 1993), which was fought between an assault force consisting of US Army Rangers, Navy Sea, Air, and Land (SEALs), and Air Force Pararescue/Combat Controllers against Somali militia fighters loyal to a warlord. During the next decade, the consequences of those bat- tles were reviewed in depth by civilian and military thought leaders. 1 Ultimately, in 1998, the Office of Naval Research commissioned the Institute of Medicine of the National Academy of Science to review published literature, conducted an international conference, and interviewed numerous au- thorities to formulate evidence-based recommendations for combat casualty care. 2 It was published in 1999, resulting in funding for initiatives, which have shaped much of the current research agenda. Several innovations in trauma care within the past decade can be directly traced to that document and are dis- cussed elsewhere within this Journal of Trauma supplement. In addition, some questioned the military’s capacity to provide care for the numbers and types of casualties expected on the modern asymmetrical battlefield. According to a report by the Congressional General Accounting Office, 3 at the end of the 20th century, many military medical personnel had either never treated trauma patients or had no recent trauma experience. The purpose of this document was to review advances in military trauma training that have occurred as a result of that report. JOINT TRAUMA TRAINING CENTER Section 744 of the National Defense Authorization Act for fiscal year 1996 required a demonstration program to ORIGINAL ARTICLE J Trauma Acute Care Surg Volume 73, Number 6, Supplement 5 S483 From the Dewitt-Daughtry Family Department of Surgery (C.M.T., M.L.R., R.M.V.H., K.G.P.), and Army Trauma Training Center (T.E.K., G.D.G.), Ryder Trauma Center, Miller School of Medicine, University of Miami, Miami, Florida; Air Force Centers for the Sustainment of Trauma and Readiness Skills (J.J.D.), University of Maryland Shock Trauma Center, Baltimore, Maryland; Navy Trauma Training Center (P.R.), Los Angeles, California; Centers for the Sustainment of Trauma and Readiness Skills Cincinnati (W.C.D.), Cincinnati, Ohio; Centers for the Sustainment of Trauma and Readiness Skills St. Louis (J.A.B.), St. Louis University, St. Louis, Missouri. P.R. is now with the Division of Trauma, Critical Care and Emergency Surgery, Arizona Health Science Center, Tucson, Arizona. W.C.D. is now with University of Cincinnati, Cincinnati, Ohio. J.A.B. is now with Joint Trauma System, US Army Institute of Surgical Research, Fort Sam Houston, Texas. T.E.K. is in private practice in Grosse Pointe Farms, Michigan. Address for reprints: Kenneth G. Proctor, PhD, Divisions of Trauma and Surgical Critical Care, Dewitt-Daughtry Family Department of Surgery, University of Miami Miller School of Medicine/Ryder Trauma Center, 1800 NW 10th Ave, Miami, FL 33136; email: kproctor@miami.edu. DOI: 10.1097/TA.0b013e31827546fb Copyright © 2012 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.