The Hamid Karzai International Airport attack during the final days of the Afghanistan withdrawal was among the most intense combat mass casualty events of the post-9/11 era. Remondelli et al describe the care delivered to combat casualties evacuated from Afghanistan to Walter Reed National Military Medical Center.1 While the authors appropriately focus on outcomes, workload, and the individual institutional response, the broader lessons learned from this event must extend beyond a single facility to the enterprise level.
The successful management of these casualties was not only the result of this single institution’s rapid scalability, but rather a reflection of a Combatant Command Trauma System built over two decades.2 The zero casualties reported from this Role 4 facility are a testament to how that complex trauma system can perform when stressed. With advanced point-of-injury care, forward multidisciplinary surgical teams, and superior evacuation pathways and processes, survivability of battlefield injuries exponentially increased over those same two decades. This superior forward medical capability provides the opportunity for the excellent definitive care, discussed in the article, to restore and recover our warfighters at our Continental United States (CONUS) Role 4 facilities.
It is imperative to mention the role that performance improvement (PI) plays across this complex trauma system. The Joint Trauma System, the DoD Center of Excellence for Trauma, spearheads PI across this complicated continuum of care.3 Through case reviews, abstraction into the DoD Trauma Registry, and analysis of data and outcomes, individual injuries become evidence-based changes in practice.4 These lessons learned yielded advancements in education and training, clinical practice guidelines, supply standards and the optimal placement of medical personnel, which measurably led to increased battlefield survivability—ultimately providing the opportunity for more warfighters to return home. It is not a single innovation, but rather this cycle of care delivery, outcome analysis, and evidence-based practice change that is the military medical enterprise’s greatest combat casualty care achievement.
Lastly, while the authors are to be commended for highlighting this single institution’s ability to scale its capacity and maintain a high quality of care, a greater lesson cannot be missed: as the Military Health System (MHS) prepares for future and large-scale combat operations, the entire enterprise must remain ready and capable to surge when called upon.5 This underscores the need for CONUS Military Treatment Facilities (MTFs) across the MHS to maintain trauma readiness through state trauma designations, American College of Surgeons verifications, and the regular and routine care of trauma patients. It is only with intentional dedication to this mission of trauma readiness across the MTFs that the MHS remains steadfast to provide the optimal outcomes our service members deserve.
Linked articles
Original research | 17 July 2026
Flagship response: a descriptive analysis of definitive surgical care at the Walter Reed National Military Medical Center following the Afghanistan withdrawal
Mason Remondelli, Natalia Barzanji, Vera Funk, Kennedy Nye, Jonathan Wang, Joseph Bozzay, Patrick Walker, Ruby Runikera, Judy Logeman, Elliot Jessie, Ashley Humphries, Eric Elster, Matthew Bradley
