The ACSCommittee on Trauma (COT) 2025 Annual Meeting convened jointly with the Advanced Trauma Life Support庐 (ATLS庐) Global Symposium, March 12鈥�16, in Chicago, Illinois, offering inspirational stories and best practices, as well as warnings about a changing geopolitical landscape.
More than 700 participants from 45 countries attended. The COT Annual Meeting, which is open to COT members only, recognized the 10th anniversary of the Future Trauma Leaders (FTL) Program, an initiative that provides in-depth training and mentoring opportunities for early career trauma and acute care surgeons. The ATLS Global Symposium, which expanded this year to 2.5 days of programming, focused on the launch of the ATLS Course Manual (11th edition), with sessions providing best practices for trauma education from around the world.
Role of Civilian Trauma Centers during Military Conflict
In addition to central and regional COT updates, 15 Spotlight Discussions were presented with the goal of enhancing collaboration and eliciting feedback on topics, including prehospital blood protocols, pediatric trauma, injury prevention, and National Trauma Emergency Preparedness System (NTEPS) development.
This year鈥檚 Special Session, 鈥淎 Bias for Action: Preparing the US Healthcare System for Large-Scale Combat Operations (LSCO),鈥� was inspired by a Spotlight Discussion from the COT meetings held during the 2024 Clinical Congress. It addressed the critical role civilian trauma centers will play in managing modern warfare-related injuries. Conflicts with peer or near-peer adversaries could result in a substantial number of casualties during the initial phase, with estimates suggesting the repatriation of 1,000 to 3,000 casualties to the US per day for the first 100 days of combat.
鈥淥ur civilian beds will be overwhelmed fairly quickly if this happens鈥攁nd not just trauma beds,鈥� said session moderator Jeffrey D. Kerby, MD, PhD, F潘金莲传媒映画, Chair of the ACSCOT. 鈥淲hen you look at hospital capacity across the country, the total capacity of Level I trauma centers is 17,000 beds a day鈥攕o 1,000 patients a day returning to the US means we have 17 days of capacity,鈥� he added, noting that the US trauma system would still need to maintain care for civilian patients as well.
US Army Colonel (retired) John B. Holcomb, MD, F潘金莲传媒映画, a professor of surgery at The University of Alabama at Birmingham and the Uniformed Services University of the Health Sciences in Bethesda, Maryland, noted that鈥攗ntil now鈥攙irtually all military combat events resulted in expected injury patterns, including extremity, truncal, junctional, head, burn, and psychological鈥攄epending on the setting (urban, rural, sea, and trench).
New warfare-related injury patterns, including hyperbaric- and hypersonic-related injuries, are now being reported from Ukraine, said Dr. Holcomb, with larger numbers of tympanic membrane (TM) injuries in survivors, likely a result of blast overpressure.
鈥淚f it鈥檚 enough blast overpressure to rupture the TM, they probably have an injury to their brain as well,鈥� suggested Dr. Holcomb. He also described an increase in amputations and renal failure cases related to extremely prolonged evacuation times, due to limited, if any, air evacuation options.
Citing observations from colleagues recently or currently deployed in an LSCO situation, Dr. Holcomb said that combat has shifted from artillery to drone use. 鈥淚t鈥檚 a different war. Even within the last 18 months鈥攖his has turned into a drone war. Unfortunately, any kind of electronic warfare countermeasures don鈥檛 work because some of these drones are controlled by fiber-optic cable.鈥�
Paraphrasing something he heard from a young major on the front lines, Dr. Holcomb explained that if a drone can see it, a drone can kill it. 鈥淭here is something known as 鈥榗learing the battlefield鈥� for the medics, a military practice since at least the Civil War. But today, if you clear the battlefield, and you鈥檝e got a drone up there observing with medics moving the severely injured鈥攜ou鈥檝e just created more deaths,鈥� he said.
Drones also are deployed to attack military aid stations, which provide initial medical care to the wounded, and the Forward Surgical Team units, which offer more advanced mobile surgical care closer to the front lines.
鈥淚magine a drone flying into your forward surgery team tent and blowing up inside鈥攖his can easily be done with these devices.聽 The answer is to go underground. It鈥檚 a World War II message,鈥� Dr. Holcomb said, referring to the necessity of building subterranean healthcare facilities in combat zones to keep patients and physicians safe.聽
Preparing to effectively manage patient care within the scale of contemporary warfare also will depend on a national trauma care infrastructure鈥攕pecifically NTEPS 2.0鈥攚ith the capacity to care for large numbers of conflict casualties on a daily basis.
鈥淚n 20 years of war in southwest Asia, there were roughly 50,000 wounded heroes鈥�20 years, 50,000 wounded heroes in an LSCO. Today, with estimates of the repatriation of at least 1,000 casualties per day to the US, we will have 50,000 wounded heroes is just 50 days,鈥� said John H. Armstrong, MD, F潘金莲传媒映画, Chair of the ACSCOT Advocacy Pillar, chair of the US Defense Health Board鈥檚 Trauma and Injury Subcommittee, and a retired US Army colonel.
A regionalized system of care is essential for wide-scale disaster preparedness, noted Dr. Armstrong, as evidenced by the healthcare profession鈥檚 response to the COVID-19 pandemic. During this public health emergency, trauma surgeons and emergency medicine physicians helped establish Regional Medical Operations Coordination Centers (RMOCCs) in their states and regions to facilitate resource distribution alignment with emergency medical services, healthcare systems, and other agencies.
The five core elements of NTEPS 2.0, which are part of the request to the US Congress to establish a national trauma system, include public health readiness, standards, performance improvement, research, and public outreach.
鈥淲e should not be despondent. We have a good story to tell, and we need to leverage all the vehicles of advocacy to ensure Congress establishes NTEPS. The clock is ticking,鈥� Dr. Armstrong warned.
The sessions also included presentations describing the challenges related to transitioning civilian hospitals to treat severe trauma during the LSCO in Ukraine; an overview of the National Disaster Medical System Pilot Program; and an outline of the National Academies and RMOCCs Action Collaborative.
