In this episode of Frontline Surgery: Mastering Military Trauma, hosts Dr. Joshua Dilday and Dr. Rachel Russo are joined by Dr. Frank Butler and Dr. John Holcomb, to examine one of the most consequential shifts in battlefield medicine: tourniquet reassessment and conversion in the era of prolonged evacuation. The episode traces the evolution of tourniquet use from its controversial origins in TCCC to the hard lessons now emerging from the Russo-Ukrainian war, where contested airspace, drone threats, and ground evacuation timelines of six hours or more have fundamentally changed the risk-benefit calculus of leaving a tourniquet on.

The panel is direct: up to 75% of tourniquets applied in the field are not medically necessary in hindsight, and with prolonged evacuation now the norm rather than the exception, unnecessary tourniquet time is costing limbs and lives. The message is not to stop using tourniquets but to use them smarter, reassess them as soon as tactically possible, convert them within two hours when feasible, and never remove them after six hours without surgical backup. Dr. Butler also previews a new plain-language training package designed for non-medical service members, built on the principle that the knowledge is only as good as the person holding the tourniquet.

Literature Mentioned:
TCCC Quick-Look:What Kind of Bleeding Requires a Tourniquet?

TCCC Quick Look: Arterial Bleeding

From application to conversion: The development of a tourniquet reassessment algorithm for nonmedical military personnel by a North Atlantic Treaty Organization specialist team

In this episode of Frontline Surgery: Mastering Military Trauma Care, host Dr. Joshua Dilday and Dr. Rachel Russo are joined by Dr. Valerie Sams and Dr. Geoffrey Anderson to discuss Critical Care Air Transport Teams (CCAT) and their essential role in moving critically injured casualties across the theater of operations and back home. From the origins of the CCAT concept to its evolution through the global war on terror, the episode covers how a three-person team of physician, nurse, and respiratory therapist delivers full-spectrum ICU care, including ECMO and continuous renal replacement therapy, at altitude and across oceans.

The conversation tackles the realities of sustainment and readiness for both active duty and reserve CCAT teams, the physiologic and operational stressors of flight that no simulation can fully replicate, and how task saturation demands flexibility from every member of the team. With LISCO on the horizon and evacuation timelines expected to lengthen in contested environments, the episode makes clear that CCAT is not simply transportation. It is an extension of the trauma care system itself, and understanding it is essential for every military surgeon preparing patients for the next phase of survival.

In this episode of Frontline Surgery: Mastering Military Trauma Care, hosts Dr. Joshua Dilday and Dr. Jeff Connor are joined by Dr. Mary Ford, infectious disease expert and the podcast's first non-surgeon guest, to tackle one of the most persistent threats in combat casualty care: battlefield infections. From contaminated blast wounds at the point of injury to multi-drug resistant organisms acquired along the evacuation chain, the episode breaks down why infection risk evolves at every stage of care and why what is in the wound on day one looks very different from what threatens the patient on day ten.

Dr. Ford walks through the spectrum of pathogens surgeons will encounter, the growing threat of invasive fungal infections in blast trauma, and why the fundamentals of infection prevention including hand hygiene and bundle-based care remain the most powerful tools available even in austere environments. The episode closes with clear takeaways for deploying surgeons: prevention is key, common things are common, operate early and often, and advocate at the command level because that is where the standards are set and where they fall apart.