A novel evaluation tool for combat trauma simulation: Delphi expert panel consensus report

BACKGROUND: Modern armed conflicts reveal increasingly complex injury patterns that challenge both civilian and military healthcare systems. In Switzerland, exposure to such injuries is limited. For a planned multicenter, high-fidelity, in-situ simulation-based study assessing trauma care performance across both military and civilian prehospital and clinical teams, a standardized and validated evaluation tool is required. The current study was designed to develop a consensus-based performance assessment tool/framework for evaluating the management of complex combat trauma, integrating civilian and military standards of care. METHODS: A structured consensus process was conducted, combining an initial nominal group technique with a multi-round Delphi process. Fourteen experts from military medicine, emergency medicine, anesthesiology, and trauma surgery participated. Assessment items were iteratively refined until predefined consensus criteria were achieved. RESULTS: Consensus was reached after five Delphi rounds. The evaluation tool includes 35 items covering key domains such as prioritization of interventions, procedural quality, adherence to trauma principles, and time to critical actions. Initial differences between civilian and military perspectives-particularly regarding cervical spine immobilization, neurological assessment, coagulation management, and fluid resuscitation-were identified and resolved through the consensus process. CONCLUSION: The results of this Delphi-based evaluation framework highlight both areas of consensus and ongoing controversy in modern combat trauma care. Differences between civilian and military perspectives are largely driven by divergent injury patterns, resources, and operational constraints. By explicitly incorporating these differences into a standardized evaluation tool, this study provides a robust framework for comparing performance across different levels of trauma care.