In this episode of Frontline Surgery: Mastering Military Trauma Care hosts Dr. Joshua Dilday and Dr. Jay Yelon are joined by Dr. Matthew Tadlock, an expert in maritime surgery and operational planning, to explore one of the most underrepresented environments in combat casualty care: surgery at sea. From burns and blast injuries aboard amphibious warships to emergency general surgery on a carrier with a single surgeon and a team of corpsmen, the episode unpacks the full breadth of what naval surgeons face and why the tyranny of time and distance demands a different kind of readiness.

The conversation covers patient movement through a threatened ship, evacuation decision-making in contested environments, and the launch of the Maritime Surgery Quality Improvement Program, which is bringing monthly case conferences, mentorship, and outcomes data to a community that previously had none. Dr. Tadlock closes with a reminder that maritime surgery is a joint problem, with Army, Air Force, and allied surgical teams increasingly integrated onto naval platforms, and that preparation for those environments has never been more urgent.

Literature Mentioned:
Expeditionary Surgery at Sea

Traumatic and Burn Injury during routine operations and war at sea

Between the Devil and the Deep Blue Sea
War at Sea: Burn Care Challenges
Injury Trends on US Navy Vessels

Elective and Emergency General Surgery
Surgery at Sea Nealeigh et al.
Surgical Care at Sea a retrospective review

Maritime Prolonged Casualty and Critical Care
Maritime Applications of PCC -Sepsis
Maritime Applications of PCC - Drowning and Hypothermia
Maritime Applications of PCC - Burns

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 small team 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.