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28 Navy | Summer 2017 formed based on the existing system for civilian hospi- tals in United States. Regions were established with teams that were responsible for transporting the wounded within their territory. Each region des- ignated a central hub where helicopters and other vehicles were located and a coordinated response system was created in both Iraq and Afghanistan. Wounded personnel could thus be transported much more quickly and efficiently than had previ- ously been the case. Another improvement that has come out of the establishment of JTS is an electronic data repository of all Department of Defense trauma-related inju- ries. e DoDTR compiles a standard set of data on each patient, including injuries sustained, treat- ments, and outcomes. e existence of this data en- ables research and analysis to be conducted that can lead to improvements in care, such as the changes in DCR blood transfusions described above. Navy CAPT Zsolt Stockinger, director of the DoD's Joint Trauma System, told Navy magazine that "for the first time in U.S. military history, we have now the ability to maintain and continually evolve an enduring military trauma system giving us the best possible outcome for every wounded warrior. e greatest contribution has been the establishment of evidence-based tactical combat casualty care and clinical practice guidelines defin- ing the battlefield standard of care." ese are based on the DoD Trauma Registry that captures casu- alty medical data, and shared through the weekly, worldwide JTS Performance Improvement telecon- ferences ongoing for more than 10 years, including hundreds of participants. Stockinger went on to say that "other major milestones include the establishment of the Com- mittee on Tactical Combat Casualty Care, and the much needed DoD Instruction, capturing 15 years of valuable battlefield experience to codify clinical guidance for the continuum of patient care." Tactical Combat Casualty Care became part of the JTS in 2013. TCCC is a set of best-prac- tice guidelines for treating combat casualties on the battlefield. Dr. Frank Butler, Chairman of the Committee on TCCC, told that "casual- ty survival is extremely high if the casualty arrives alive at a surgical treatment facility." By using the TCCC guidelines, medics, corpsmen, and other first responders can dramatically improve the likelihood of the casualty reaching the treatment facility alive. Because every combat theater is different, the JTS does not dictate exactly how a trauma system should be set up or operated, but serves as a resource that can help combatant commanders and others rely on MC1 GARY L. JOHNSON III LCDR Yorel Hickerson of the Expeditionary Resuscitative Surgical System team conducts an ultrasound on a simulated battlefield trauma patient during their field environment training at Joint Expeditionary Base Little Creek-Fort Story.

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