Defining Components of a DoD Globally Integrated Trauma System: A Global Review of Evidence, Policy, and Practice

Document Type

Journal Article

Publication Date

2-6-2026

Journal

Military medicine

DOI

10.1093/milmed/usaf616

Abstract

INTRODUCTION: The Department of Defense (DoD) has greatly reduced combatant morbidity and mortality in the last twenty years. Nevertheless, current distance, environment, and workforce challenges threaten these gains. Moreover, existing models predict current trauma system capacity is insufficient for large-scale combat operations. One potential solution is a globally integrated trauma system. This review sought to examine global research and policy on civilian and military trauma systems to identify necessary components for a DoD globally integrated trauma system (GTS). MATERIALS AND METHODS: This critical interpretive synthesis identified global theory, practice, and policy within trauma care to develop a framework for a DoD GTS. The World Health Organization's Building Blocks of Health served as the literature review conceptual framework, supplemented with core areas of trauma identified by the research team and other experts. Broad, browser-based searches were performed to identify global variations in trauma care terminology and locate national policy documents. Once key terms were established, more stringent searches were performed using the PubMed, Scopus, ProQuest, and EBSCOhost databases. A total of 2,791 results were screened, and 47 sources met the inclusion criteria. Data extraction composed of closed- and open-ended questions was performed by two independent researchers. The responses were compiled into one response to conduct descriptive statistics and define essential components for a DoD GTS. RESULTS: Although the United States was the most frequently featured nation in publications, the U.S. Indo-Asia Pacific Command region had the largest representation. Governance and service delivery were the most cited building blocks of health. Protocols/guidelines and trauma centers were the most frequently cited core areas of trauma, followed by education/training, prehospital care, and data collection/registries. The emerging DRIVE (Domains of Responsibility, Influence, Values, and Execution) framework consists of four domains: trauma system responsibilities; trauma system levers; management, implementation, and operation; and qualities and values. Responsibilities could be subdivided into care delivery, trauma registries, injury prevention and safety promotion, political advocacy, and research and innovation. CONCLUSIONS: A GTS is an innovative strategy to address the risk to mission and force generated by existing DoD trauma system capacity shortfall. If developed appropriately across the four domains identified in this study, the system can enable the DoD to strengthen relationships with ally and partner nations, promote knowledge sharing, and improve global health outcomes. This study benefited from coalescing findings from 24 years of publications. However, the broad timeframe may have resulted in the inclusion of outdated information. Moreover, only publications in English were included for data extraction. Future research could counteract these limitations through interviews with in-country subject matter experts. Moving forward, the DoD should develop a GTS strategy informed by the current trauma system capacity risk in each Combatant Command, identify specific partner nations that could help close the gap, develop an engagement plan to establish necessary agreements, and create an implementation plan to guide execution. Doing so increases access, placement, and interoperability although mitigating operational risk. The DoD should capitalize on this opportunity to develop a GTS that provides a north star for all stakeholders involved.

Department

Public Health Student Works

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