Evolution of biomedical research during combat operations

BACKGROUND: The implementation of a human research protection program in Afghanistan and the mobilization of the combat casualty research team have made it possible to design and efficiently conduct multifaceted, multisite, and prospective research studies in a combat environment. Still, to conduct research in such an environment, several unique challenges must be overcome. METHODS: This article describes the development and conduct of three ongoing trauma-related biomedical research studies in Afghanistan, highlighting the challenges and lessons learned within the context of these studies. RESULTS: Key challenges include the process of developing and getting approval for in-theater research protocols, the informed consent process, and logistics of conducting a biomedical research study in an austere environment. Despite these challenges, important lessons learned that can contribute to the success of a protocol include the need for clear operating procedures, judicious selection for which data points must be collected in-theater, and the importance anticipating the "fog and friction" of war. CONCLUSION: As we continue the journey toward more sophisticated research capabilities in combat, this article will help inform the design and conduct of future research performed in a theater of war. Conducting biomedical research in a combat zone is an important but difficult element of military medicine.