1. The CENTCOM Trauma Care Perspectives: It’s all about the SYSTEM
CAPT Darin K Via, MC, USN
Command Surgeon
US Central Command
Overall Classification of this brief is
UNCLASSIFIED

2. 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.

3. 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.

4. 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

5. 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

6. US Central Command AOR

7. 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

8. 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.

9. 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

10. 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

11. 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

12. 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)

13. 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

14. Questions

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