DoD Trauma System

• Development of Clinical Practice Guidelines
• Continuous review and update of CPGs
• Robust performance improvement monitoring
• Rapid implementation of data driven improvements
• Weekly Performance Improvement Trauma video teleconferences
• Monthly killed in action preventable death reviews
• Ranger Prehospital Trauma Registry
• Rapid publication of clinical and research results

Tactical Evacuation (TACEVAC)

• Use of paramedic-level providers or higher in TACEVAC platforms
• Fresh whole blood use and guidelines
• Tranexamic acid (TXA) on evacuation platforms
• Advanced capability evacuation platforms (e.g., Medical Emergency Response Team)
• Overfly Role 2's when Role 3 is close

Guidelines support

• Critical care air transportation teams in en route care (intra theater and strategic evacuation)
• Extracorporeal membrane oxygenation teams in en route care (strategic evacuation)

Tactical Combat Casualty Care

• Aggressive use of tourniquets for extremity hemorrhage
• Surgical airways for maxillofacial trauma with obstructed airway
• Hypotensive resuscitation with Hextend for casualties in shock
• Hypothermia prevention in casualties
• Battlefield antibiotics (PO and IV)
• Tranexamic acid for casualties at risk of significant hemorrhage
• Eye injuries
• PO pain meds

Facility-Based Clinical Care

• Damage Control Resuscitation
• Damage Control Surgery
• 1:1:1 plasma: platelets: Packed red blood cells transfusion ratio for hemorrhagic shock
• FWB when needed
• Decompressive craniectomy
• Temporary vascular shunting at all Role 2 and above
• Delayed removal of intraocular foreign bodies
• Aggressive use of fasciotomy in extremity injuries
• Negative pressure wound therapy
• Improved management of wound infections