The National Capital Region HKIA attack response: A course of action for optimizing casualty receiving systems in the Military Health System

The mass casualty event at the Hamid Karzai International Airport (HKIA) in the summer of 2021 marked the exit of the U.S. military from Afghanistan. While the Military Health System (MHS) has continuously received patients to the U.S. from abroad throughout the Global War on Terrorism (GWOT), this event was the first in recent years to truly stress the Role 4 definitive care (R4DC) casualty receiving system within the National Capital Region (NCR). The influx of casualties from the HKIA attack into the NCR was examined from a trauma systems perspective, which elucidated multiple areas of improvement for optimized care, resource allocation, and health readiness. These aspects were further categorized into the following: casualty receiving and transport, triage, command and control, and special considerations. After reviewing the HKIA attack response, system-level considerations were analyzed, and recommendations were made to refine all the casualty receiving systems in the MHS. Additional discussion was further provided towards integration with the ongoing planning of the American College of Surgeons (ACS) National Trauma and Emergency Preparedness System (NTEPS) and National Disaster Medical System (NDMS) for inclusive R4DC. This editorial sets a course of action for military and civilian medical leaders to ensure that an integrated MHS-civilian casualty receiving and trauma system is best prepared for potential mass casualty events during future large-scale armed conflicts.