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

Abstract

Background: In 2019, the Joint Trauma System Committee on Surgical Combat Casualty Care (CoSCCC) identified the "Top 10" research and development priorities for forward operation. Since then, readiness planning has shifted toward large-scale combat operations (LSCO), which is expected to produce higher casualty volumes coupled with significant resource constraints.

Methods: Additional questions addressing anticipated LSCO threats were included with previous research questions from the 2019 web-based survey, which was distributed to CoSCCC membership who ranked topics on a Likert scale from 1 (low) to 10 (high priority). An analysis of demographics, descriptive and univariate statistics and inter-rater correlation (IRC) was performed.

Results: Of 73 surveys, 94.5% of respondents were military. Inter-rater agreement was high (IRC coefficient = 0.91, CI:0.88-0.93). 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/bio-artificial blood substitutes (9.12) and blood product transfusion and storage optimization (8.99). The greatest decrease in priority from 2019 was on Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA).

Conclusion: The 2025 survey identified a broader set of priorities spanning five focus areas. Underscoring unresolved threats, four topics from 2019 persisted. Six new topics highlighted emerging needs. Priorities shifted away from REBOA toward blood product optimization and shelf-stable or bio-artificial substitutes - critical for resource constrained environments - as well as treatment for burn and CBRN in large-scale combat operations.