Secretary of Defense Robert Gates' 60-minute medevac mandate in 2009 halved patient transportation times and saved over 350 lives in Afghanistan.3 Personal protective equipment has improved - between my first and most recent deployment I have received better small arms protective insert plates, side small arms protective inserts, a new vest and helmet, shoulder and groin protectors, protective undergarments, and bottles of ibuprofen and talcum powder to mitigate the burden of all of the above. A civilian trauma system is an enduring thing, based upon permanent fixed facilities that can codify their improvements and mature over time; dedicated medical transportation assets that have no other role; with long-term staff and leadership, many of whose careers are centered on trauma care; functioning within a system that is focused on, if not exclusively, medical. How patients are treated should also be standardized, as exemplified by Tactical Combat Casualty Care (TCCC) and the highly successful JTS Clinical Practice Guidelines (CPGs) printed in this supplement, which have been shown to improve clinical outcomes.15,16 These are important if not critical to good care, especially when that care is provided by personnel whose jobs are not normally traumarelated. The JTS' operational cycle as seen in Figure 2 does this through clinical data collection and abstraction into a dedicated trauma registry, analysis of both individual and aggregated patient data to identify clinical problems and best practices, and then feeding those lessons learned and best practices back into daily patient care downrange, to restart the process and track improvement and change.