Why military medical research?

Abstract

The challenging circumstances that confronted military caregivers during the years of war in Afghanistan and Iraq established the imperative for military-oriented medical research. The burden of injury and illness resulting from this long period of combat operations, and the unique clinical and logistical considerations it engendered provide a compelling rationale for requirement-driven, well-coordinated medical research. Also referred to as “gap” driven and programmed, military trauma research is specifically aimed at providing readily deployable solutions to reduce morbidity and mortality from war-related injury. From a strategic standpoint, the approach taken by military medical research is quite different from that sponsored by other federal research agencies, which typically fund investigator-initiated studies of interest to the scientific community, irrespective of the urgency of the question to society. Importantly, neither these agencies nor private foundations dedicate funding to injury research of the type or severity that can be anticipated in modern warfare including terrorism. Military research has been shown effective in reducing the case fatality rate during combat and has established itself as the centerpiece of the military’s continuously learning health system. 1,2 It has also generated numerous advances that are being translated to improving civilian trauma care. 3 The following paragraphs of this preface and the articles in this supplement provide examples that serve to emphatically answer the question, “Why military medical research?” Between 2005 and 2013, the fatality rate for service personnel injured in Afghanistan decreased by 50% while the severity of injury was increasing. 1,2 The reason for this unprecedented achievement is multifactorial, but two factors stand out. At the height of the wars in Afghanistan and Iraq, the military health system made (1) significant investments in requirement-driven, programmed trauma research, and (2) an extraordinary effort to codify a trauma system that identified emerging needs for research, and rapidly translated results from military research into best clinical practices. The first element was comprised of programmatic research performed by the individual services (Army, Navy, and Air Force) and through the Joint-service, Defense Health Program. The sec