The 59th Trauma, Critical Care and Acute Care Surgery conference met this spring at Caesars Palace in Las Vegas. This course has been running since 1967, which makes it the longest-running show in Las Vegas by most accounts. Caesars itself opened the year before the first meeting. Every year, trauma surgeons, intensivists, emergency physicians, medics and nurses travel to Las Vegas to review real cases, debate changes in practice, and share what they are learning on the front lines. I have been coming to this meeting for years, and each time I leave with something I take directly back to the operating room or the lab.
In 2026, I served on the Program Committee and as part of the core faculty and leadership team. That role carries real responsibility. The sessions we build have to be practical. They have to address problems that trauma teams actually face, not just problems that are interesting in theory. The three topics I focused on this year reflect that standard.
Drones and the Problem of Distance
The first topic I addressed was drone delivery in trauma care and emergency response. This is not a futuristic concept. It is a present and growing reality in military settings, in rural communities, and in disaster zones around the world.
The core problem is simple. When a patient is bleeding severely, time is everything. Every minute between injury and access to blood or life-saving supplies reduces the chance of survival. In an urban trauma center with a blood bank two floors down, that gap is manageable. In a remote community where the nearest hospital is an hour away, or in a combat environment where roads are compromised and weather grounds helicopters, that gap can be fatal.
Drones can close that gap. A small unmanned aircraft can carry whole blood, medications, tourniquets, and other critical supplies to locations that would take ground transport far longer to reach. I walked the audience through scenarios in rural emergency response, disaster relief, and forward military positions. The point was not to suggest that drones replace helicopters or paramedics. They do not. The point is that drones extend the reach of the system. They get the right resources to the right place faster, and in trauma care, faster almost always means better.
Using Thromboelastometry to Guide Resuscitation
The second topic was thromboelastometry and how it changes the way we manage hemorrhagic shock. Standard coagulation labs give us some information, but they take time to return and offer only a partial picture. In a patient who is bleeding rapidly, a trauma team cannot wait 45 minutes for lab results before deciding whether to give plasma, platelets, fibrinogen, or whole blood.
Thromboelastometry works differently. It gives near-real-time feedback on how a patient is forming and stabilizing clots. It tells you where the clotting process is breaking down. Is the initial clot forming slowly? Is it forming but not gaining enough strength? Is it forming and then dissolving too quickly? Each of those problems calls for a different intervention.
The traditional approach has been to treat every bleeding trauma patient with a fixed ratio of blood products. That approach has saved lives and represents a significant advance over what we did 20 years ago. But it also means some patients receive products they do not need and others receive products in the wrong proportion. Thromboelastometry allows teams to target specific deficits. It makes resuscitation more precise.
This matters for outcomes. It also matters for resource stewardship. Blood products are scarce and expensive. Using them well is both a clinical obligation and a practical necessity, particularly in military and austere settings where supply chains are limited. My broader work on resuscitation science connects directly to this question. If you want to understand how research in hemorrhage control is reshaping the way trauma teams treat bleeding patients, this is one of the clearest examples I can point to.
The REBOA Debate
The third session was a structured debate on retrograde endovascular balloon occlusion of the aorta, or REBOA. This technique involves placing a catheter into the aorta and inflating a balloon to slow or stop bleeding below the level of the balloon. It can also maintain blood flow to the heart and brain during a critical window when the patient would otherwise deteriorate too quickly to reach the operating room.
REBOA is not a simple or universally applicable tool. It requires training, clear protocols, and careful patient selection. The debate I participated in covered when to consider REBOA, which surgical teams should use it, and how to integrate it into established trauma pathways without creating delays in definitive care. We did not treat it as a solution for all non-compressible hemorrhage. We treated it as a focused option that may benefit specific patients under specific conditions.
That kind of honest, evidence-based debate is what the TCCACS meeting does well. Attendees hear the strongest case for a technique and the strongest case against it. They hear about outcomes from urban trauma centers and from smaller regional hospitals. They hear from military surgeons who have used these techniques in austere conditions and from academic surgeons who have studied them in controlled settings. The goal is always the same. Give clinicians clear, actionable information they can take home and use the next time they receive a call about a major trauma.
Moving to Madigan Army Medical Center
Beyond the conference, this year marks a significant transition in my own career. I have accepted a full-time, general-schedule federal position as a general surgeon at Madigan Army Medical Center on Joint Base Lewis-McChord, just south of Tacoma in Washington State.
In this role, I will care for surgical patients across the full clinical spectrum, including the clinic, the operating room, hospital wards, and the intensive care unit. I will teach medical students and residents who rotate through Madigan. And I will continue conducting clinical, animal, and basic science research with a sustained focus on trauma and resuscitation.
I will also remain affiliated with the Uniformed Services University. That connection matters to me. USU links daily clinical work to formal research and education in military medicine. It keeps me engaged with the broader community of military surgeons and with the academic infrastructure that supports advances in trauma care. Lessons from deployment and operational settings have shaped civilian trauma practice in fundamental ways, and I want to remain part of that ongoing exchange.
I have served as a Colonel in the United States Army Reserve since 1984. That career, combined with my years leading trauma care and research at Oregon Health and Science University, shapes how I evaluate every new idea in this field. The lens is practical. Does this work in real life, in real time, when a patient is bleeding and a team has only minutes to act? That question filters everything.
Staying Connected to the Broader Mission
Outside the hospital and the laboratory, I volunteer with the American Red Cross in support of emergency preparedness and disaster response. That work connects to the same principles that drive my clinical and research focus. Hemorrhage control, system readiness, and well-trained responders save lives long before any specific patient arrives at a trauma center. Preparation matters. Training matters. Getting the right resources in the right place before a crisis begins matters.
This past January, I was named Reviewer of the Month by the Journal of Trauma and Acute Care Surgery. That recognition reflects a commitment I have held throughout my career: the peer review process is how the field protects the integrity of the science. Reviewing papers carefully and honestly is not a burden. It is part of the obligation that comes with being a member of this community.
Taken together, the work at the 59th TCCACS conference, the move to Madigan, the ongoing affiliation with USU, the Red Cross volunteer work, and the peer review commitment all reflect the same underlying purpose. I want to be useful at every level where the science meets the patient. That means the lecture hall, the operating room, the research lab, and the training programs that prepare the next generation of trauma surgeons and combat medics. The work spans all of those spaces, and I intend to keep it that way.