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J Am Acad Orthop Surg, Vol 14, No 10, September 2006, S7-S9.
© 2006 the American Academy of Orthopaedic Surgeons
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Levels of Medical Care in the Global War on Terrorism

COL Mark R. Bagg, MD, MC, USA, CAPT Dana C. Covey, MD, MC, USN and COL Elisha T. Powell, IV, MD, MC, FS, USAF

Dr. Bagg is Chairman, Department of Orthopaedics and Rehabilitation, Brooke Army Medical Center, San Antonio, TX. Dr. Covey is Chairman, Department of Orthopaedics, Naval Medical Center San Diego, San Diego, CA. Dr. Powell is Chief of Surgery, Department of Orthopaedics, Wilford Hall Medical Center, San Antonio.

None of the following authors or the departments with which they are affiliated has received anything of value from or owns stock in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Bagg, Dr. Covey, and Dr. Powell.

The opinions expressed herein are those of the authors and are not necessarily representative of those of the Department of Defense (DOD); or the United States Army, the United States Navy, or the United States Air Force.

Trauma care for military personnel injured in Iraq has become increasingly sophisticated. There are five levels, or echelons, of care, each progressively more advanced. Level I care provides immediate first aid at the front line. Level II care consists of surgical resuscitation provided by highly mobile forward surgical teams that directly support combatant units in the field. Level III care is provided through combat support hospitals—large facilities that take time to become fully operational but offer much more advanced medical, surgical, and trauma care, similar to a civilian trauma center. Level IV care is the first echelon at which definitive surgical management is provided outside the combat zone. Level V care is the final stage of evacuation to one of the major military centers in the United States, where definitive stabilization, reconstruction, or amputation of the injured extremity is performed.






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