Challenges to Improving Combat Casualty Survival on the Battlefield

We succeed only as we identify in life, or in war, or in anything else, a single overriding objective, and make all other considerations bend to that one objective." -Dwight D. EisenhowerThe United States has achieved unprecedented survival rates (as high as 98%) for casualties arriving alive to the combat hospital.Official briefings, informal communications, and even television documentaries such as CNN Presents Combat Hospital highlight the remarkable surgical care taking place overseas.Military physicians, medics, corpsman, and other providers of battlefield medical care are rightly proud of this achievement.Commanders and their troops can be confident that once a wounded service member reaches the combat hospital, their care will be the best in the world.Combat casualty care, however, does not begin at the hospital.It begins in the field at the point of injury and continues through evacuation to the combat hospital or forward surgery.This prehospital phase of care is the first link in the chain of survival for those injured in combat and represents the next frontier for making further significant improvements in battlefield trauma care.Even with superb in-hospital care, recent evidence suggests up to 25% of deaths on the battlefield are potentially preventable. 1,2The vast majority of these deaths happen in the prehospital setting.The indisputable conclusion is that any meaningful future improvement in combat casualty outcomes depends on closing the gap in prehospital survival.Improving prehospital combat casualty care, however, may be significantly more challenging than improving hospital based casualty care because of significant structural challenges facing the military medical establishment.We describe 5 key challenges and a plan to overcome them.