Critical care at Landstuhl Regional Medical Center.

BACKGROUND: Landstuhl Regional Medical Center is the largest U.S. medical facility outside the United States, and it is the first permanently positioned hospital outside the combat zone providing care to the wartime sick and wounded. As of November 2007, Landstuhl Regional Medical Center personnel have treated over 45,000 patients from Operations Enduring Freedom and Iraqi Freedom. The current trauma/critical care service is a multidisciplinary, intensivist-directed team caring for a diverse range of clinical diagnoses to include battle injuries, diseases, and nonbattle injuries. Admissions arise from an at-risk population of 500,000 widely distributed over a geographic area encompassing three continents. DISCUSSION: When compared with 2001, the average daily intensive care unit census has tripled and the patient acuity level has doubled. Combat casualties account for 85% of service admissions. The clinical practice at this critical care hub continues to evolve as a result of wartime damage control trauma care, robust critical care air transport capabilities, length of stay, and other unique factors. The service's focus is to optimize patients for an uneventful evacuation to the United States for definitive care and family support. SUMMARY: Successful verification in 2007 as an American College of Surgeons level II trauma center reflects a continuing institutional commitment to providing the best possible care to the men and women serving our nation in the global war on terror.