A Conceptual Framework for Non-Military Investigators to Understand the Joint Roles of Medical Care in the Setting of Future Large Scale Combat Operations

Abstract As the wars in Iraq and Afghanistan end, the US military has begun to transition to the multi-domain operations concept with preparation for large scale combat operations against a near-peer adversary. In large scale combat operations, the deployed trauma system will likely see challenges not experienced during the Global War on Terrorism. The development of science and technology will be critical to close existing capability gaps and optimize casualty survival. This review comprises a framework of deployed trauma care to provide nonmilitary investigators a general understanding of our deployed trauma care system. Trauma care begins at the Role 1 which encompasses all care from the point of injury and the battalion aid station, through transport to the Role 2 or forward staged mobile surgical team such as a Forward Resuscitative Surgical Detachment. Role 1 point of injury care approximates the care delivered by Emergency Medical Services (EMS) personnel. The Battalion Aid Station approximates the care available at a freestanding emergency center with significant differences in training level of the providers, number of beds, and diagnostic capabilities. Role 2 medical care is part of an area support medical company with surgical capabilities. The Role 2 represents the first role of care which provides damage control surgery. This capability approximates a small community hospital with the primary difference being limited patient holding capacity and reduced diagnostic equipment. The Role 3 field hospital is the largest military treatment facility in the deployed setting. The Role 3 approximates a civilian level 2 trauma center with smaller holding capabilities and diagnostic abilities limited to that of a computed tomography (CT) scanner and less.