The 2023 Military Health System Research Symposium opened with a plenary panel discussion with the theme "Casualty Care Across the Continuum: Operational Vignettes" on Aug. 14.

The panel was moderated by Dr. Terry Rauch, executive director, health readiness policy and oversight, and the director of the research and development office of the assistant secretary of defense for health affairs, and Dr. John Holcomb, professor of trauma and acute care surgery at the University of Alabama Birmingham Department of Surgery.

Rauch told the audience, "We want you to draw from the vast knowledge and experience of these experts seated before you as they relate their experiences and training with the wounded in combat, with the goal of providing lessons learned to guide us for the future fight."

The panelist’s expertise spanned the continuum of combat care from role 1, triage and stabilization, to role 2, damage control, resuscitation, surgery, and evacuation, to role 3, treatment in a military hospital or clinic, to role 4, additional treatment and rehabilitation in our major military hospitals and clinics in the continental United States.

"The guidance to this panel was to tell us what you did, how it went, and some scenarios," said Holcomb. "Tell us what you wish you had, whether it be training equipment, devices, or product."

The first speaker, U.S. Army Master Sergeant, Kaleb Twilligear, Department of Defense operational medicine expert and retired 20-year combat medic, addressed role 1 care. He related some of the challenges he faced during his 2009 deployment in the Nuristan province of Afghanistan.

"The biggest issue was preventive medicine," said Twilligear. "We focus on trauma as the big elephant in the room. But historically, it's the preventive medicine. Ten days of fighting. Everyone's dirty, everyone's dehydrated, everyone's malnourished, a lot of folks are getting sick. We're setting up for cellulitis infections, both bacterial and fungal... all these things that, unfortunately, many people believe we have beat."

U.S. Army Col. Jennifer Gurney, chief of Joint Trauma System, focused on role 2 care. "When I was thinking about the things a research community should focus on, I thought of the word ‘test’," said Gurney. "We need to focus on training, experience, standards and standardization, as well as tools for the deployed environment."

Gurney said 90% of combat deaths occur within the first hour. "That’s our time to make a difference. We need to figure out ways to extend the golden hour."

Dr. Phillip Mason is the medical director of both the cardiothoracic and transplant intensive care unit and adult extracorporeal membrane oxygenation at University of Texas Health San Antonio, talked about critical care transport.

"There's a lot of opportunity to improve situational awareness through centralized monitoring, and smarter alarms," said Mason. "Centralized monitoring can be as easy as a large screen on the aircraft where all the vital signs are displayed. Maybe it's a tablet with a heads-up display that shows these vital signs full time. A smarter alarm might be something as simple as an audible signal that goes into the team's headset to call their attention to something they need to know about and not looking at."

Mason focused on relatively simpler technological improvements over more advanced solutions like artificial intelligence.

"Those are all active lines of research, and they have merit and they're extremely valuable," said Mason. "We have long maintained our edge by looking to the future, sometimes far, far into the future. That's a valuable endeavor. We shouldn't be doing that while we're overlooking these very immediate problems that we can solve with the technology that's already widely available. To put it in military terms: we are focusing on 1000-meter targets, and we are surrounded by 10-meter targets that somehow are going unnoticed."

The final panelist, Dr. Paul Pasquina, the chair of physical medicine and rehabilitation at Uniformed Services University of the Health Sciences, and the department chief of rehabilitation at Walter Reed National Military Medical Center, spoke on the rehabilitation of combat casualties.

"What is rehabilitation?" asked Pasquina. "We try to take people with the most devastating combat related trauma and get them back to doing their highest level of function."

Pasquina emphasized the importance of early rehabilitation delivered by interdisciplinary teams, "that provide patient and family education, early mobilization, training on activities with daily living, neurocognitive stimulation for those who have traumatic brain injury and aggressive pain management that reduces secondary complications."

"Science today is a team sport," said Pasquina. "We need to all be on the same team."