2025 Update to Committee on Surgical Combat Casualty Care Research Gap Analysis: Top 10 Research and Development Priorities for Battlefield Surgical Care.

Abstract

In 2019, the Joint Trauma System Committee on Surgical Combat Casualty Care identified the "top 10" research and development priorities for forward operation. Since then, readiness planning has shifted toward large-scale combat operations (LSCO), which are expected to produce higher casualty volumes coupled with significant resource constraints. Additional questions addressing anticipated LSCO threats were included with previous research questions from the 2019 web-based survey, which was distributed to the Committee on Surgical Combat Casualty Care membership, who ranked topics on a Likert scale from 1 (low) to 10 (high priority). An analysis of demographics, descriptive and univariate statistics, and interrater correlation was performed. Of 73 surveys, 94.5% of respondents were military. Interrater agreement was high (interrater correlation coefficient 0.91, 95% CI 0.88 to 0.93). Top 5 focus areas included personnel number, mix, and capabilities (7.36); resuscitation and initial hemorrhage management (7.07); Chemical, Biological, Radiation, Nuclear, and Explosives (CBRNE) events and patients (6.87); pain/sedation/anxiety management (6.81); and burn injuries (6.67). CBRNE had the largest positive mean score change (+0.41). Top research priorities included creating dried or shelf-stable blood products/bioartificial blood substitutes (9.12) and optimizing blood product transfusion and storage (8.99). The greatest decrease in priority from 2019 was on REBOA. The 2025 survey identified a broader set of priorities spanning 5 focus areas. Underscoring unresolved threats, 4 topics from 2019 persisted. Six new topics highlighted emerging needs. Priorities shifted away from REBOA toward blood product optimization and shelf-stable or bioartificial substitutes-critical for resource-constrained environments-as well as treatment for burns and CBRNE in LSCO.