Assessing readiness for large-scale combat operations across the full spectrum of medical and surgical capabilities

BACKGROUND: Readiness for large-scale combat operations (LSCOs) remains a persistent challenge for military and civilian medical providers. This study assessed physicians' self-reported confidence in delivering damage-control resuscitation and damage-control surgery in LSCOs scenarios and identified opportunities for improvement (OFIs). METHODS: A 40-item survey was distributed to all deployable Armed Forces' physicians (active duty, residents, reservists, contractors, and civilians) with military medical training. The survey explored confidence in performing lifesaving interventions across 15 tactical and medical scenarios and collected suggested OFIs. RESULTS: Of 2,145 eligible physicians, 474 (22%) responded: 51% active duty, 21.5% residents, and 18% reservists. The median time since graduation was 7 years (interquartile range, 1-13). Among respondents, 11% reported high confidence, 18% moderate, and 71% low. Compared with the low-confidence group, high-confidence physicians were older (median age, 40.0 vs. 34.0 years; p < 0.001), more often male (86.0% vs. 51.5%, p < 0.001), and more frequently reservists (30.0% vs. 15.5%, p = 0.005). Surgeons and anesthesiologists/intensivists were overrepresented in the high-confidence group ( p < 0.001). Daily clinical activity in trauma center level 1 facilities was more common among high-confidence physicians (62.7% vs. 27.5%, p < 0.001). Multivariate analysis identified significant associations between high confidence and performing lifesaving procedures both domestically and overseas (odds ratio [OR], 1.13; p < 0.001), being an anesthesiologist (OR, 9.56; p = 0.002), and the number of years after graduation (OR, 1.05; p = 0.044). Simulation-based training was the most frequently cited OFI, followed by regular clinical exposure in trauma centers and online interprofessional knowledge exchange. Key training needs identified included crew resource management, prolonged casualty care, and multiple-organ failure management. CONCLUSION: Confidence in damage-control resuscitation and damage-control surgery delivery during LSCOs remains limited. Structured, experiential, and specialty-specific training is essential to improve preparedness in deployed medical teams. ( J Trauma Acute Care Surg . 2026;101: S7-S16. Copyright © 2026 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Association for the Surgery of Trauma.). LEVEL OF EVIDENCE: Prognostic and Epidemiological; Level IV.