The homefront: Role 4 and 5 care

The nature of wartime military trauma care leads to distinct clinical and logistical challenges. Transferring a casualty through staged, geographically disparate sites of care can impair communication and impact clinical decision-making. It is impossible to know with certainty what has fully transpired before you receive a patient. Although a segmental and dynamic trauma system is in place, the potential for fragmented care requires thorough review of the patient and extreme vigilance on the part of the clinician. When the patient reaches the Role 4 facility, any missed or neglected details must be captured and corrected. Although the process of medical evacuation and communication of the downrange events and interventions became very streamlined during the decade-plus of combat operations in OIF and OEF, this was not so in the early years of the conflicts and would not be expected to be any better in the early phases of the next conflict. The final destination of the "acute care" phase for these patients is the Role 5 facility in the United States. Although much of the analysis discussion of combat care has been focused on the Role 1 through Role 3 levels, the care at the Role 5 level is equally as important and in many ways substantially more difficult. The management of multiple body system injuries, chronic wound and wound complication management, head-to-toe evaluations including behavioral and neuropsychiatric, amputation and prosthetics management, and many others all need to be executed and coordinated to maximize the rehabilitation and recovery from what are often devastating injuries.