Excerpt from A Legacy of Lessons Learned: Landstuhl Regional Medical Center During Wartime, 2001-2014: For over 25 years, Landstuhl Regional Medical Center (LRMC) has served as a model of “selfless service,” stepping up to the demands of a suddenly increased rate of traumatically injured service members arriving from the battlefield. From Operations Desert Storm/Desert Shield; through the attacks in Somalia, the Khobar Towers, and USS Cole; to the recent conflicts in Afghanistan and Iraq, LRMC has stood at the forefront of military healthcare, receiving our Nation’s and our partners’ wounded and ill from battlefields and contingencies across multiple theaters. From a community hospital providing routine healthcare delivery to personnel stationed in Europe and their families before 9/11, LRMC transitioned into a Level 1, triservice, integrated trauma center, providing lifesaving care to tens of thousands of evacuated service members, in addition to handling all the associated needs of these patients, from payroll assistance to chaplain services, service and unit liaison support, and veteran service organization support, as well as delivering ongoing healthcare to beneficiaries across Europe, Africa, and Asia. The goal of this text is to share the lessons learned by LRMC staff in converting from a peacetime to wartime footing, serving as a guide for US military hospitals in similar situations in the future. The innovations and solutions planned and implemented so successfully by LRMC staff will assist future military medical and line leaders in maintaining the highest quality of healthcare services for future generations of our service men and women in combat, improving upon the historically high survival rates seen in these conflicts. Related items: Physician References & Medical Handbooks can be found here: https://bookstore.gpo.gov/catalog/health-benefits/physician-references-medical-handbooks Army Medical Department (AMEDD) publications can be found here: https://bookstore.gpo.gov/agency/1141 Army Medical Department Center and School publications can be found here: https://bookstore.gpo.gov/agency/1065 Army Medical Research Institute for Infectious Diseases (USAMRIID) publications can be found here: https://bookstore.gpo.gov/agency/1306 Army Surgeon General Office publications can be found here: https://bookstore.gpo.gov/agency/1142 The Borden Institute publications can be found here: https://bookstore.gpo.gov/agency/1140

Excerpt from A Legacy of Lessons Learned: Landstuhl Regional Medical Center During Wartime, 2001-2014: For over 25 years, Landstuhl Regional Medical Center (LRMC) has served as a model of “selfless service,” stepping up to the demands of a suddenly increased rate of traumatically injured service members arriving from the battlefield. From Operations Desert Storm/Desert Shield; through the attacks in Somalia, the Khobar Towers, and USS Cole; to the recent conflicts in Afghanistan and Iraq, LRMC has stood at the forefront of military healthcare, receiving our Nation’s and our partners’ wounded and ill from battlefields and contingencies across multiple theaters. From a community hospital providing routine healthcare delivery to personnel stationed in Europe and their families before 9/11, LRMC transitioned into a Level 1, triservice, integrated trauma center, providing lifesaving care to tens of thousands of evacuated service members, in addition to handling all the associated needs of these patients, from payroll assistance to chaplain services, service and unit liaison support, and veteran service organization support, as well as delivering ongoing healthcare to beneficiaries across Europe, Africa, and Asia. The goal of this text is to share the lessons learned by LRMC staff in converting from a peacetime to wartime footing, serving as a guide for US military hospitals in similar situations in the future. The innovations and solutions planned and implemented so successfully by LRMC staff will assist future military medical and line leaders in maintaining the highest quality of healthcare services for future generations of our service men and women in combat, improving upon the historically high survival rates seen in these conflicts. Related items: Physician References & Medical Handbooks can be found here: https://bookstore.gpo.gov/catalog/health-benefits/physician-references-medical-handbooks Army Medical Department (AMEDD) publications can be found here: https://bookstore.gpo.gov/agency/1141 Army Medical Department Center and School publications can be found here: https://bookstore.gpo.gov/agency/1065 Army Medical Research Institute for Infectious Diseases (USAMRIID) publications can be found here: https://bookstore.gpo.gov/agency/1306 Army Surgeon General Office publications can be found here: https://bookstore.gpo.gov/agency/1142 The Borden Institute publications can be found here: https://bookstore.gpo.gov/agency/1140

Excerpt from A Legacy of Lessons Learned: Landstuhl Regional Medical Center During Wartime, 2001-2014: For over 25 years, Landstuhl Regional Medical Center (LRMC) has served as a model of "selfless service," stepping up to the demands of a suddenly increased rate of traumatically injured service members arriving from the battlefield. From Operations Desert Storm/Desert Shield; through the attacks in Somalia, the Khobar Towers, and USS Co≤ to the recent conflicts in Afghanistan and Iraq, LRMC has stood at the forefront of military healthcare, receiving our Nation's and our partners' wounded and ill from battlefields and contingencies across multiple theaters. From a community hospital providing routine healthcare delivery to personnel stationed in Europe and their families before 9/11, LRMC transitioned into a Level 1, triservice, integrated trauma center, providing lifesaving care to tens of thousands of evacuated service members, in addition to handling all the associated needs of these patients, from payroll assistance to chaplain services, service and unit liaison support, and veteran service organization support, as well as delivering ongoing healthcare to beneficiaries across Europe, Africa, and Asia. The goal of this text is to share the lessons learned by LRMC staff in converting from a peacetime to wartime footing, serving as a guide for US military hospitals in similar situations in the future. The innovations and solutions planned and implemented so successfully by LRMC staff will assist future military medical and line leaders in maintaining the highest quality of healthcare services for future generations of our service men and women in combat, improving upon the historically high survival rates seen in these conflicts. Related items: Physician References & Medical Handbooks can be found here: https://bookstore.gpo.gov/catalog/health-benefits/physician-references-medical-handbooks Army Medical Department (AMEDD) publications can be found here: https://bookstore.gpo.gov/agency/1141 Army Medical Department Center and School publications can be found here: https://bookstore.gpo.gov/agency/1065 Army Medical Research Institute for Infectious Diseases (USAMRIID) publications can be found here: https://bookstore.gpo.gov/agency/1306 Army Surgeon General Office publications can be found here: https://bookstore.gpo.gov/agency/1142 The Borden Institute publications can be found here: https://bookstore.gpo.gov/agency/1140

"The goal of military medicine is to conserve the fighting force necessary to prosecute just wars. Just wars are defensive or humanitarian. A defensive war protects one's people or nation. A humanitarian war rescues a foreign, persecuted people or nation from grave human rights abuse. To provide medical care during armed conflict, military medical ethics supplements civilian medical ethics with two principles: military-medical necessity and broad beneficence. Military-medical necessity designates the medical means required to pursue national self-defense or humanitarian intervention. While clinical-medical necessity directs care to satisfy urgent medical needs, military-medical necessity utilizes medical care to satisfy the just aims of war. Military medicine may therefore attend the lightly wounded before the critically wounded or use medical care to win hearts and minds. The underlying principle is broad, not narrow, beneficence. The latter addresses private interests, while broad beneficence responds to the collective welfare of the political community"--

Advances in trauma care have accelerated over the past decade, spurred by the significant burden of injury from the wars in Afghanistan and Iraq. Between 2005 and 2013, the case fatality rate for United States service members injured in Afghanistan decreased by nearly 50 percent, despite an increase in the severity of injury among U.S. troops during the same period of time. But as the war in Afghanistan ends, knowledge and advances in trauma care developed by the Department of Defense (DoD) over the past decade from experiences in Afghanistan and Iraq may be lost. This would have implications for the quality of trauma care both within the DoD and in the civilian setting, where adoption of military advances in trauma care has become increasingly common and necessary to improve the response to multiple civilian casualty events. Intentional steps to codify and harvest the lessons learned within the military's trauma system are needed to ensure a ready military medical force for future combat and to prevent death from survivable injuries in both military and civilian systems. This will require partnership across military and civilian sectors and a sustained commitment from trauma system leaders at all levels to assure that the necessary knowledge and tools are not lost. A National Trauma Care System defines the components of a learning health system necessary to enable continued improvement in trauma care in both the civilian and the military sectors. This report provides recommendations to ensure that lessons learned over the past decade from the military's experiences in Afghanistan and Iraq are sustained and built upon for future combat operations and translated into the U.S. civilian system.

Specialty Volume of Textbooks of Military Medicine. TMM. Edited by Shawn Christian Nessen, Dave Edmond Lounsbury, and Stephen P. Hetz. Foreword by Bob Woodruff. Prepared especially for medical personnel. Provides the fundamental principles and priorities critical in managing the trauma of modern warfare. Contains concise supplemental material for military surgeons deploying or preparing to deploy to a combat theater.