The CENTCOM Trauma Care Perspectives: It’s all about the SYSTEM CAPT Darin K Via, MC, USN Command Surgeon US Central Command 813-529-0345 Darin.k.via.mil@mail.mil Overall Classification of this brief is UNCLASSIFIED

Disclosures The views and opinions expressed in this presentation are those of the author and do not necessarily reflect the official policy of the Department of Defense, U.S. Central Command, or the Department of the Navy. The presenter has no financial relationships to disclose. This continuing education activity is managed and accredited by Professional Education Services Group in cooperation with AMSUS. Neither PESG, AMSUS, nor any accrediting organization support or endorse any product or service mentioned in this activity. PESG and AMSUS staff has no financial interest to disclose. Commercial support was not received for this activity.

Learning Objectives: At the conclusion of this activity, the participant will be able to: 1. Recognize that the trauma system must also include pre-hospital care, and understand the importance of line commander support to emphasize and enforce compliance with TCCC guidelines. 2. Understand that a theater trauma system embodies much more than dedicated support teams such as the JTTS, and includes capabilities and contributions from across the DOTMLPF spectrum. 3. Recognize any trauma system ultimately depends upon properly trained and equipped personnel, the delivery of care in accordance with established best practices, and the commitment to process improvement by capturing, analyzing, and learning from past experiences.

Department of Defense The Secretary of Defense (SecDef) USCENTCOM: Geographic Combatant Command for all US forces in the 20 country CENTRAL region (Lebanon, Syria, Egypt, Jordan, Saudi Arabia, Yemen, Oman, United Arab Emirates, Qatar, Bahrain, Kuwait, Iraq, Iran, Pakistan, Afghanistan, Turkmenistan, Tajikistan, Kazakhstan, Uzbekistan, & Kyrgyzstan) The Secretary of Defense (SecDef) Principal assistant to POTUS; all functions in DOD are performed under the authority, direction, and control of SecDef Supported by various agencies of the Office of the Secretary of Defense (OSD) e.g. DTRA The Joint Chiefs of Staff CJCS, VCJS, Service Chiefs (JCS) CJCS is principal military advisor to POTUS and SecDef, communicates their orders (not in chain of command) The Joint Staff supports the JCS Services (Army, Navy, Air Force, Marines) Primary function: train, organize, and equip forces for operational missions Provide administrative control for all service forces and C2 for forces not on operational missions Combatant Commands Geographic Combatant CDRs link between POTUS/SecDef to operational military forces; provides strategic direction, assign missions, tasks, and resources Functional Combatant CDRs are responsible for large areas requiring single responsibility Functional Geographic

AOR Characteristics (U) UNCLASSIFIED AOR Characteristics (U) World’s most energy-rich region 64% of world’s petroleum reserves 46% of natural gas reserves Strategic choke points Bab al Mandab Suez Canal Strait of Hormuz Religious, ethnic, and tribal tensions Youth Bulge 15-29 age group constitutes over 40% of the population in 18 of 20 states Inadequate economic development, insufficient basic services, and poor governance The most kinetic GCC in the last 50 years 20 Countries Spanning 4.6M Sq Miles 530 Million People and 4 Major Religions 18 Major Languages/22 Ethnic Groups

US Central Command AOR

Vision-Mission-Strategic Approach Mission-Vision We envision a more stable and prosperous region with increasingly effective governance, improved security and trans-regional cooperation to counter state and non-state actors posing a threat to U.S. interests. To this end – our USCENTCOM mission is to direct and enable military operations and activities with allies and partners to increase regional security and stability in support of enduring U.S. interests. Strategic Approach Prepare - Pursue - Prevail

USCENTCOM Strategic Environment (U) UNCLASSIFIED USCENTCOM Strategic Environment (U) Approved 24FEB15 SUNNI-SHIA Ideologues/politicians perpetuate an “Us vs. Them” narrative Local/religious affinities trump national identities, secularism External actors exploit divisions Tajikistan Qatar Kuwait Kazakhstan Uzbekistan Kyrgyzstan Turkmenistan Afghanistan Pakistan Iran U.A.E. Oman Yemen Saudi Arabia Iraq Jordan Egypt Bahrain Lebanon Syria ISRAELI-PALESTINIAN Contentious, fuels sectarianism and violence Third intifada could spark conflict Ongoing diplomatic efforts IRQ-SYRIA & GREATER LEVANT IRQ: ISIL threatens the global stability SYR: Grinding civil war, groups via for power JOR, LEB, TUR: Risk of spillover violence Confrontations Situations Conflicts PAKISTAN-INDIA Trust deficit between nuclear powers Sporadic cross-border violence, military persists IRAN Persistent nuclear ambitions Growing operational reach, malign influence threatens U.S., allies, region DRIVERS OF INSTABILITY Political / economic grievances persist Disenfranchisement, economic uncertainty, and humanitarian crises Stalled political transitions and renewed autocracy Ungoverned / Under-governed spaces AFGHANISTAN-PAKISTAN AFG political transition fragile AFG-PAK safe havens enable extremist organizations and threaten regional stability YEMEN Potential civil war portends state collapse/ fracture AWAP safe haven; Iran support to Huthis Turmoil threatens geostrategic choke point PERCEPTION OF U.S. ENGAGEMENT Competition to supplant U.S. influence U.S. intervention fuels distrust & anger Security cooperation with regional partners in high demand USCENTCOM’s strategic environment contains converging and compounding threats, instability, and violence as political transitions, civil wars, and aggressive violent extremist organizations threaten global security and stability.

Evolving Challenges National Perception of War’s End Decreased Funding-Increased Funding Competition Force Reduction/Restructuring Mission Change Extreme Disaggregated Operations Decreased Evacuation Coverage Victim of Our Own Success WMD Risk Re-emergence Maintaining Readiness Rapid Turnover of Deployed Personnel

Systematic Successes JTTS/JTS (The true definition of a HRO) Mandatory JTS CPG implementation Mandatory Combat Life Savor pre-deployment training Mandatory TCCC training Improved Personal Protective Equipment Tourniquets DCS/DCR Blood Product Availability and Optimized Transfusion Practices Patient Movement AE CCAT TCCET

Remaining Gaps and Concerns DCS/DCR for Extreme Disaggregated Operations Capacity/Competency Equipment Logistics Class VIII and Class VIIIB Demand Signal JTTS to JTS JPMRC to TPMRC Intratheater Movement Standards IMIT Networks Telemedicine

Current Theater Efforts Blood Products: Medevac (Update of Vampire CCOP) Role 2 Low Titer O Whole Blood Cold Platelets in Platelet Additive Solution (5 days - 14 days?) Intra-theater Patient Movement Policy/Standards MEDSITREP/MEDCOP IM/IT Telemedicine IPL submission of capability gaps Value driven use of JLLIS with a DOTMLPF-P aligned product that drives an output that is a capability gap JCIDS input Intratheater recovery policy (Urgent-elective surgical capability)

External Opportunities Continued Codifying of CENTCOM Lessons Learned in Joint Policy DHAs Role as a Combat Support Agency and standardization across the shared services Sustainment of the JTS IMIT Agile, modular, scalable, interoperable HSS capabilities. (JCHS, AUG 15) Coordination of medical gaps in IPL submission processes across COCOMs Organizational Restructuring of the Defense Health System to better align with our value proposition of READINESS

Questions

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