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

BACKGROUND: In 2019, the Joint Trauma System Committee on Surgical Combat Casualty Care identified the "top 10" research and development priorities for forward operation. Since then, readiness planning has shifted toward large-scale combat operations (LSCO), which are expected to produce higher casualty volumes coupled with significant resource constraints. STUDY DESIGN: Additional questions addressing anticipated LSCO threats were included with previous research questions from the 2019 web-based survey, which was distributed to the Committee on Surgical Combat Casualty Care membership, who ranked topics on a Likert scale from 1 (low) to 10 (high priority). An analysis of demographics, descriptive and univariate statistics, and interrater correlation was performed. RESULTS: Of 73 surveys, 94.5% of respondents were military. Interrater agreement was high (interrater correlation coefficient 0.91, 95% CI 0.88 to 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/bioartificial blood substitutes (9.12) and optimizing blood product transfusion and storage (8.99). The greatest decrease in priority from 2019 was on REBOA. CONCLUSIONS: The 2025 survey identified a broader set of priorities spanning 5 focus areas. Underscoring unresolved threats, 4 topics from 2019 persisted. Six new topics highlighted emerging needs. Priorities shifted away from REBOA toward blood product optimization and shelf-stable or bioartificial substitutes-critical for resource-constrained environments-as well as treatment for burns and CBRNE in LSCO.