Trauma system development and the joint trauma system

A report by Mullins and colleagues identified the benefits of trauma systems in the late 1990s. When war developed in response to the September 11 attack on the World Trade Center and Pentagon, the concepts of trauma systems had yet to be incorporated into the US military medical planning. Col John Holcomb, Commander of the US Army Institute of Surgical Research, traveled to Iraq for a survey of trauma care. The survey was conducted in May 2003, 2 months after onset of hostilities. He identified no trauma system existed in Iraq. Medical planning had indeed been conducted, but in many circumstances, the planning was service specific. Col Holcomb, Col Don Jenkins (US Air Force), and Lt Col Brian Eastridge (US Army Reserve) proposed the establishment of a theater trauma system for the entire battlespace. The proposal to establish a Joint Theater Trauma System for the US Central Command (CENTCOM) area of responsibility was subsequently approved. Critical to the success of the Joint Theater Trauma System (JTTS) was assigning the Director of the JTTS directly responsible to the CENTCOM Surgeon. By doing so, the JTTS Director served as the CENTCOM Surgeon's advisor on combat casualty care. For issues in the CENTCOM area of responsibility that could not be resolved locally by the JTTS Director, the CENTCOM Surgeon would provide direction. This command oversight was imperative in the complex environment of a theater of operations. Over the subsequent decade-plus of sustained combat operations in Iraq and Afghanistan, the JTTS achieved unparalleled success in data collection, real-time data analysis, and robust evidence and data-based quality/process improvement initiatives. The implementation of the JTTS, now known as the Joint Trauma System (JTS) as it encompasses care along the entire continuum and not just "in theater," is widely credited for achieving improved battlefield survival despite an increase in the average injury severity and the lowest battlefield mortality statistics in history.