Combat casualty care: Partnering for preparedness.

T theme for this year’s supplement, ‘‘Partnering for Preparedness,’’serves notice to the nation regarding the urgency to maintain our investment in combat casualty care research, both to benefit our US military service members and to best prepare our nation on the home front. Department of Defense funding primarily seeks to optimize combat casualty care for US service members injured in conflict. In the face of military budget cuts, we must seek increased partnerships to stay ahead of the curve in combat casualty care research and to maintain our lessons learned to sustain readiness. Similarly, we are all compelled to improve care for injured American citizens. This shared goal is especially relevant and timely, given the increasing number of intentional mass casualty events on the home front. We don’t need another ‘‘history repeats itself ’’ lesson to prove to us the importance of military and civilian collaboration in trauma care. We already know that during war research is stimulated by large casualty volumes leading to advances in combat casualty care. Our society then indirectly benefits from these advances through the adaptation of combat casualty care lessons to the care of injured citizens. We also know that between wars we seek to sustain and improve our trauma knowledge by leveraging the expertise in research and training at our nation’s civilian trauma centers. Unfortunately, our national and military leadership has the tendency to quickly forget the importance of advances made through a dedicated and focused investment in operationally relevant, gap-driven trauma research. In addition, the skills of combat casualty care experienced physicians, nurses, medics, and ancillary staff rapidly fade because of attrition to civilian life and because of a lack of dedicated sustainment of trauma skills as these military medical personnel return to a military facility practices not involving routine trauma care. In an unsettling way, we are told that we have reached the conclusion of military conflicts in Iraq (2012) and in Afghanistan (2014), yet we remain involved with a significant number of US Military service members deployed in harm’s way in both locations. In addition to Afghanistan and Iraq, we are also engaged globally with small military teams working in dispersed and remote locations such as in Africa and Asia without the benefit of a robust Joint Trauma System, which has given us the lowest case fatality rate in military history. Equally concerning, we are experiencing an increase in the frequency and number of intentional mass casualty events from active shooter and intentional bombings on the home front. Almost daily, we see news reports of events involving multiple casualty scenarios right here on our home soil. We face an onslaught of intentional harm events with increasing complexity and are compelled to act with urgency to ensure that investment is commensurate to the importance of supporting ongoing military operations and civilian mass casualty preparedness. Increased funding for trauma research and partnership between military and civilian trauma communities are essential to meet this threat. Internationally, we must also partner for preparedness. Part of our success in providing a Joint Trauma System for two theaters of operation for over a decade has been the result of a mutually beneficial investment in preparedness in combat casualty care across multiple nations. Our ability to work together to provide trauma care has fostered international medical partnerships in trauma care that would not otherwise have been possible. The fruits of this international investment are FOREWORD