Joint Trauma System

Joint Trauma System

In this episode of Frontline Surgery: Mastering Military Trauma Care, host Dr. Joshua Dilday is joined by Dr. Jennifer Gurney, Chief of the Joint Trauma System (JTS), and Dr. Mike Van Gent, Chief of the Defense Committee on Trauma, to discuss the JTS and how it shapes combat casualty care from the point of injury through recovery. The conversation unpacks the JTS operational cycle of act, learn, and adjust, how clinical practice guidelines are developed and continuously updated, and why documentation and performance improvement are not bureaucratic exercises, but life-saving ones. The episode makes a direct case for why early-career military surgeons need to understand the JTS before they deploy, not after. From weekly Thursday PI calls to real-time trauma log reviews to the growing library of nearly 90 CPGs, the JTS is the infrastructure behind every good outcome on the battlefield. As Dr. Gurney puts it: if you take care of combat casualties and you write it down, you are already part of the system. Literature Mentioned: JTS CPG: Damage Control Resuscitation [https://jts.health.mil/assets/docs/cpgs/Damage_Control_Resuscitation_12_Jul_2019_ID18.pdf]JTS CPG: Damage Control Resuscitation in Prolonged Field Care [https://jts.health.mil/assets/docs/cpgs/Damage_Control_Resuscitation_PFC_01_Oct_2018_ID73.pdf]JTS CPG: Prehospital Blood Transfusion [https://jts.health.mil/assets/docs/cpgs/Prehospital_Blood_Transfusion_30_Oct_2020_ID82.pdf]

Maritime Trauma

In this episode of Frontline Surgery: Mastering Military Trauma Care hosts Dr. Joshua Dilday and Dr. Jay Yelon are joined by Dr. Matthew Tadlock, an expert in maritime surgery and operational planning, to explore one of the most underrepresented environments in combat casualty care: surgery at sea. From burns and blast injuries aboard amphibious warships to emergency general surgery on a carrier with a single surgeon and a team of corpsmen, the episode unpacks the full breadth of what naval surgeons face and why the tyranny of time and distance demands a different kind of readiness. The conversation covers patient movement through a threatened ship, evacuation decision-making in contested environments, and the launch of the Maritime Surgery Quality Improvement Program, which is bringing monthly case conferences, mentorship, and outcomes data to a community that previously had none. Dr. Tadlock closes with a reminder that maritime surgery is a joint problem, with Army, Air Force, and allied surgical teams increasingly integrated onto naval platforms, and that preparation for those environments has never been more urgent. Literature Mentioned: Expeditionary Surgery at Sea [https://link.springer.com/book/10.1007/978-3-031-21893-4] Traumatic and Burn Injury during routine operations and war at sea Between the Devil and the Deep Blue Sea [https://www.aast.org/asset/399ED6E9%2DC029%2D4F4A%2DA67CA7BF5183CBE0/] War at Sea: Burn Care Challenges [https://www.aast.org/asset/AF3E0439%2D616E%2D4672%2DB2DB01EAB1447DE4/] Injury Trends on US Navy Vessels [https://www.aast.org/asset/0502F167%2DE64D%2D4B56%2D88D209F2146215AD/] Elective and Emergency General Surgery Surgery at Sea Nealeigh et al. [https://www.aast.org/asset/8E7B20E9%2D52E3%2D45AE%2D83900B09398F351A/] Surgical Care at Sea a retrospective review [https://www.aast.org/asset/F471AD7C%2DF923%2D4E65%2D8CAC80331D9232DD/] Maritime Prolonged Casualty and Critical Care Maritime Applications of PCC -Sepsis [https://www.aast.org/asset/319D7B16%2D9806%2D4E37%2D8C9896DEC0203BEF/] Maritime Applications of PCC - Drowning and Hypothermia [https://www.aast.org/asset/177BDE16%2D9D58%2D4E49%2D898AA27FE175386B/] Maritime Applications of PCC - Burns [https://www.aast.org/asset/6D5D6BEC%2D3922%2D4598%2DA418624ED8DF886F/]

The Role of Critical Care Air Transport

In this episode of Frontline Surgery: Mastering Military Trauma Care, host Dr. Joshua Dilday and Dr. Rachel Russo are joined by Dr. Valerie Sams and Dr. Geoffrey Anderson to discuss Critical Care Air Transport Teams (CCAT) and their essential role in moving critically injured casualties across the theater of operations and back home. From the origins of the CCAT concept to its evolution through the global war on terror, the episode covers how a small team delivers full-spectrum ICU care, including ECMO and continuous renal replacement therapy, at altitude and across oceans. The conversation tackles the realities of sustainment and readiness for both active duty and reserve CCAT teams, the physiologic and operational stressors of flight that no simulation can fully replicate, and how task saturation demands flexibility from every member of the team. With LISCO on the horizon and evacuation timelines expected to lengthen in contested environments, the episode makes clear that CCAT is not simply transportation. It is an extension of the trauma care system itself, and understanding it is essential for every military surgeon preparing patients for the next phase of survival.

Managing Infection in Combat Casualty Care

In this episode of Frontline Surgery: Mastering Military Trauma Care, hosts Dr. Joshua Dilday and Dr. Jeff Connor are joined by Dr. Mary Ford, infectious disease expert and the podcast's first non-surgeon guest, to tackle one of the most persistent threats in combat casualty care: battlefield infections. From contaminated blast wounds at the point of injury to multi-drug resistant organisms acquired along the evacuation chain, the episode breaks down why infection risk evolves at every stage of care and why what is in the wound on day one looks very different from what threatens the patient on day ten. Dr. Ford walks through the spectrum of pathogens surgeons will encounter, the growing threat of invasive fungal infections in blast trauma, and why the fundamentals of infection prevention including hand hygiene and bundle-based care remain the most powerful tools available even in austere environments. The episode closes with clear takeaways for deploying surgeons: prevention is key, common things are common, operate early and often, and advocate at the command level because that is where the standards are set and where they fall apart.

Bleeding Control Episode 1: Prehospital

In this episode of Frontline Surgery: Mastering Military Trauma, hosts Dr. Joshua Dilday and Dr. Rachel Russo are joined by Dr. Frank Butler and Dr. John Holcomb, to examine one of the most consequential shifts in battlefield medicine: tourniquet reassessment and conversion in the era of prolonged evacuation. The episode traces the evolution of tourniquet use from its controversial origins in TCCC to the hard lessons now emerging from the Russo-Ukrainian war, where contested airspace, drone threats, and ground evacuation timelines of six hours or more have fundamentally changed the risk-benefit calculus of leaving a tourniquet on. The panel is direct: up to 75% of tourniquets applied in the field are not medically necessary in hindsight, and with prolonged evacuation now the norm rather than the exception, unnecessary tourniquet time is costing limbs and lives. The message is not to stop using tourniquets but to use them smarter, reassess them as soon as tactically possible, convert them within two hours when feasible, and never remove them after six hours without surgical backup. Dr. Butler also previews a new plain-language training package designed for non-medical service members, built on the principle that the knowledge is only as good as the person holding the tourniquet. Literature Mentioned: TCCC Quick-Look:What Kind of Bleeding Requires a Tourniquet? [https://www.aast.org/asset/DADFD895%2DD295%2D4A5D%2D9F45F8D92940991C/] TCCC Quick Look: Arterial Bleeding [https://www.aast.org/static/807f9eb5-d416-461a-bff6dc18aab59665/TCCC-260521-TCCC-Quick-Look-Holcomb-Video-Arterial-BleedingMOV.mov] From application to conversion: The development of a tourniquet reassessment algorithm for nonmedical military personnel by a North Atlantic Treaty Organization specialist team [https://pubmed.ncbi.nlm.nih.gov/40622167/]