Major scientific lessons learned in the trauma field over the last two decades

Over the last 20 years, care for injured patients has undergone a revolution.As noted by many authors, war's only silver lining is to improve the care of the injured, and this era is no exception.Why do wars always seem to change the existing paradigm?Most experienced military personnel describe a 100% focus on the injured, stemming from the emotional impact of proximity to the battlefield, the close living and working quarters of medical personnel and combatants, and the sense of duty towards those who are injured while serving their country.Whatever the reasons, the results speak for themselves.The present era of conflict, starting on September 11, 2001 and continuing today is no exception.Amazing changes have occurred in care in the combat theater, and some of these have transitioned into the civilian world.This is critically important, as the scope of the civilian injury problem is 300 times that of the military, while military-style injuries are, unfortunately, becoming more common in civilian life.Trauma teams used to "stay and play": we'd start with two large-bore intravenous (IV) lines and if the patient lived several hours infuse 20-30 liters of crystalloid and transfuse 10 units of red blood cells (RBCs) before thinking about ordering any other component.We would stay in the operating room and repair all injuries and then close the fascia on everyone, delay repair of fractures, use high tidal volume ventilation, and studiously avoid any minimally invasive techniques.The inevitable coagulopathy, renal failure, abdominal compartment syndrome, wound complications, and acute respiratory distress syndrome were considered acceptable diseases of survivorship.Death rates were high, survivors infrequently utilized rehabilitation centers, and follow-up for traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD) patients was rare.In the following few words, many areas of improvement are described.As with all descriptions of current status, the work is not done and continued progress is mandatory.Of course, this list is not all-inclusive; inevitably something important has been left out, and for that I apologize in advance. TrainingFor all members of the trauma team, training used to be haphazard, simulation centers were essentially nonexistent, and military personnel were trained utilizing the same concepts that were developed for civilian casualties.Today, prehospital and hospital team training is commonplace and integrated, simulation centers are widespread and the training and equipment designed for the military environment is commonplace as Tactical Combat Casualty Care (TCCC) spreads across the globe [1].A focus on current trauma experience has become accepted as critical for optimal patient outcomes in both the short and long term [2].These concepts have transitioned variably into clinical practice in the civilian world, where mass