Predicting Interoperability: A Retrospective Comparison of Combat Casualty Care Delivered to French and U.S. Casualties During Recent Conflicts.
Military Medicine · 2026-08-01 · Observational study
Abstract
BACKGROUND: Based on data from the U.S. Department of Defense Joint Trauma Registry, the Joint Trauma System has developed clinical practice guidelines for combat casualty care (CCC). As future high-intensity conflicts are likely to involve multinational operations, interoperability with allied nations-whose trauma systems may differ from established U.S. practices-is essential. This study aimed to compare key characteristics of French and U.S. military trauma systems to anticipate interoperability in CCC. MATERIALS AND METHODS: This retrospective observational study included all U.S. and French service members (SMs) who sustained a severe battle injury requiring intensive care unit admission between 2009 and 2022. Demographics, prehospital management, and in-hospital interventions, including transfusions and tranexamic acid administration, were analyzed. RESULTS: A total of 734 U.S. and 98 French SMs met inclusion criteria. Most U.S. casualties occurred in Afghanistan (96.3%), whereas French casualties were mainly engaged in Africa after 2013 (51.0%). U.S. SMs sustained more improvised explosive device-related injuries (54.3% vs. 33.7%, P < .001) and fewer penetrating injuries (68.1% vs. 84.7%, P < .001) than French SMs. French SMs were more frequently managed by a prehospital physician (80.6% vs. 53.1%), received more prehospital transfusions (16.3% vs. 7.9%, P = .005), and more tranexamic acid (28.6% vs. 7.9%, P < .001). Median transport time from point of injury to surgical care was longer for French SMs (120 vs. 50 minutes). CONCLUSIONS: Both trauma systems emphasize early prehospital transfusion. Key differences include mechanisms of injury, the presence of a physician in prehospital teams, early tranexamic acid use, and evacuation timelines. Enhancing interoperability will require strengthened international data sharing, harmonization of competencies, and sustained collaboration in CCC.
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Tags
Blood products · Fluids & blood · Haemostatics · Interagency collaboration · Military & tactical · Prehospital physicians · Tranexamic acid
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