Ready before the call: Integration of civilian surgeons into a combat casualty care clinical readiness program for large-scale combat operations.

ABSTRACT: Large-scale combat operations will generate casualty volumes and injury patterns that fundamentally differ from routine civilian trauma, yet contingency planning increasingly relies on civilian surgeons and hospitals to deploy, absorb, and definitively treat combat-injured patients through frameworks such as the National Disaster Medical System and Health Care Personnel Delivery System. Decades of experience, from World War II and the Global War on Terrorism to the current war in Ukraine, demonstrate that civilian surgical volume alone does not reliably translate into readiness for combat casualty care. Contemporary warfare produces blast and high-velocity fragment trauma, severe polytrauma, extensive contamination, complex extremity and vascular injuries, burns, and prolonged evacuation delays, requiring serial operative management and decision making under resource constraints. In contrast, civilian trauma systems are predominantly blunt injury-based with rapid access to definitive resources and subspecialty support. The Military Health System mitigates this readiness gap through the Clinical Readiness Program (CRP), a Knowledge, Skills, and Abilities (KSA) based framework that standardizes combat-relevant education, procedural training, and experience validation. No comparable readiness requirement exists for civilian surgeons despite their anticipated wartime role, creating a mismatch between assumed capacity and validated capability. This opinion argues that civilian clinicians expected to support combat casualty care should be incorporated into a civilian combat casualty care readiness framework modeled on the CRP. Key elements include specialty-specific curricula, knowledge assessments, periodic skills-based training aligned to deployment requirements, and KSA scoring using case log review to enable role assignment across echelons of care. Before activation, clinicians would undergo standardized education, skills verification, and team-based training. A scalable civilian readiness framework would enable rapid, effective, and safe integration of civilian surgeons into large-scale combat operations and responses, ensuring that providers are objectively prepared and ready before the call. (J Trauma Acute Care Surg. 2026;000: 000-000. Copyright © 2026 Wolters Kluwer Health, Inc. All rights reserved.).