The US military’s early combat casualty care experience during Operation Enduring Freedom in Afghanistan was first described in 2003.1 This publication presaged a rapid string of enhancements to battlefield aeromedical evacuation resuscitative capabilities that improved the outcomes of service members who were critically injured in Afghanistan’s complex, climatologically diverse, and geographically sprawling battle space. In 2003, the United States had not yet established integrated trauma system capabilities in Afghanistan or Iraq (both covered by US Central Command). Recognizing this deficiency, military medicine rapidly developed and implemented an interservice Joint Trauma System to ensure that optimal, timely care was delivered to injured soldiers when needed. Concurrent collection and analysis of clinical data were established to deliver, assess, and refine best practices through a process that has been described as “focused empiricism.”2,3 This process entailed using registry-based clinical data to optimize practices in topic areas in which randomized clinical studies are not possible or feasible using the best data available at the time to make adjustments in care.2,4
Elster EA, Bailey J. Prehospital Blood Transfusion for Combat Casualties. JAMA. 2017;318(16):1548–1549. doi:10.1001/jama.2017.15096
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