Why Trauma Readiness Begins Long Before an Emergency

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Why Trauma Readiness Begins Long Before an Emergency

In November 2025, Dr. Jay Johannigman retired from the United States Army Reserve at the rank of colonel, closing 46 years of military service across the Air Force and the Army. He had already come home to Cincinnati that July.

He did not slow down.

Johannigman now works with regional hospitals, emergency medical services, and public safety agencies across Greater Cincinnati on a single question: what happens on the worst day, before anyone has time to figure it out. It is the same question he spent eight combat deployments answering, and his position is that the answer is decided long before the injury occurs.

Readiness, in his framing, is not a state of alertness. It is a design problem.

A career built at the boundary between the injury and the operating room

Johannigman came to trauma medicine from the wrong end of it.

He served as a volunteer and professional firefighter in the Ohio Valley before beginning his medical career, joining a volunteer fire department while an undergraduate at Kenyon College. He arrived at car wrecks and structure fires and industrial accidents, and he saw what determined outcomes there. It was rarely surgical skill. It was whether the people on scene knew what to do and whether the system moved fast enough to matter.

That perspective survived his training. He earned an A.B. in biology from Kenyon College, then earned his medical degree from Case Western Reserve University School of Medicine in 1983, where he served as president of the Alpha Omega Alpha honor medical society and was an honor student in pharmacology. He completed his surgical residency and a fellowship in surgical critical care at the University of Cincinnati Medical Center, training there from 1983 to 1990 at the institution that would anchor his civilian career. He was already commissioned as an officer in the Air Force Reserves when that training ended.

During his military years he returned to school again, completing the Aerospace Medicine Primary Course at Brooks Air Force Base and graduating from the Air War College. He has held his rating as a flight surgeon throughout.

Between 2003 and 2021, Dr. Johannigman completed eight combat deployments to Iraq and Afghanistan, operating at forward facilities including Craig Joint Theater Hospital in Bagram. He served as a CCAT flight surgeon, as trauma director for the 332nd Air Force Theater Hospital at Balad Air Base in Iraq, as deputy commander and director of clinical services for combat hospitals, as consultant surgeon for Air Force Special Operations Command, and as a consultant to the Office of the Surgeon General of the Air Force at the Pentagon.

His decorations include the Legion of Merit, the Bronze Star Medal, the Army Commendation Medal, and multiple Meritorious Service Medals. He has contributed to more than 100 peer-reviewed publications and has advised the Department of Defense on trauma and critical care policy.

He is a Fellow of the American College of Surgeons and a Fellow of the American College of Critical Care Medicine, and he holds membership in the American Association for the Surgery of Trauma, the Eastern Association for the Surgery of Trauma, and the Western Trauma Society.

Those experiences continue to shape his current work with hospitals and emergency response agencies. It matters because of what he built along the way, and because each thing he built solved a problem that civilian medicine also has.

The intensive care unit had to learn to fly

The problem was easy to state.

A wounded service member could be stabilized at a forward surgical facility and still be thousands of miles from definitive care. The flight itself was often the most dangerous stretch of the journey. Under the old model, the patient had to be stable enough to survive that flight largely unattended, which meant many patients waited on the ground for a stability that never arrived.

At Wilford Hall USAF Medical Center, where he served as staff surgeon and medical director of the Surgical Critical Care Service, Johannigman took part in the original formulation of the Critical Care Air Transport Team concept.

CCATT put a physician, a critical care nurse, and a respiratory therapist onto the aircraft, along with the equipment to run a working intensive care unit at altitude. The patient no longer had to be stable enough to fly. The ICU flew with them.

The model changed how far a critically injured patient could travel and how quickly they could start moving. Johannigman has stayed involved in critical care aeromedical transport in the decades since.

The civilian parallel is immediate. Rural hospitals, mountain communities, and any region where the nearest capable center is an hour away face a version of the same constraint.

Skills decay when there are no patients to treat

Military trauma teams face a problem that sounds strange until you say it plainly. Between deployments, they have no trauma patients.

A surgeon who spent a year treating blast injuries returns to a stateside assignment and may go months without seeing penetrating trauma. The skill fades. The next deployment starts from a lower baseline than the last one ended.

Civilian trauma centers have the opposite problem and the opposite resource. They see injury every week.

In 2001, Johannigman joined the faculty at the University of Cincinnati Medical Center and played a founding role in establishing the Cincinnati Center for the Sustainment of Trauma and Readiness Skills, known as Cincinnati C-STARS. The program embeds military physicians, nurses, and medics into a working civilian trauma center so their skills stay current between deployments.

Cincinnati C-STARS was among the first five military-civilian strategic partnerships in the country and has served as the advanced course training center for Air Force critical care air transport teams since its founding. It has now run continuously for more than two decades.

The exchange runs both directions. Military teams keep their readiness. Civilian trauma practice absorbs techniques developed under conditions no civilian hospital would choose to replicate, including tourniquet use, hemorrhage control, and transfusion strategy that reached civilian emergency departments through exactly this kind of partnership.

Johannigman served as director of trauma, surgical critical care, and acute care surgery at University Hospital, now part of UC Health, from 2001 to 2017, and as director of the Institute of Military Medicine at the University of Cincinnati College of Medicine. Under his leadership the division grew from four surgeons to a multidisciplinary team of more than 40 providers working across two ACS-verified trauma centers. He also led the effort that brought West Chester Hospital to verified Level III trauma center status, and served as director of its Surgical Critical Care Service and associate director of its Trauma Service.

Blood is a logistics problem before it is a clinical one

Johannigman later practiced at Brooke Army Medical Center in San Antonio and served as trauma medical director at St. Anthony Hospital in Lakewood, Colorado, where he oversaw a Level I trauma and emergency general surgery program verified by the American College of Surgeons.

Colorado presented a specific version of a familiar problem. Patients were bleeding to death in mountain communities during transport. The blood that would have saved them existed. It was simply in the wrong place.

He built a whole blood initiative aimed at positioning blood closer to the patients likely to need it, applying to civilian geography a lesson learned under combat conditions. Hemorrhage does not wait for the supply chain.

The insight generalizes past blood. A capability that exists somewhere else, at the moment it is needed, is functionally a capability that does not exist.

The most common serious injury is not the one people picture

Ask most people to imagine a trauma patient and they will describe a car crash or a shooting.

The regional data tells a different story. Falls among older adults account for a substantial share of trauma volume, and those patients follow a clinical course that differs meaningfully from younger trauma patients. Injuries that a thirty-year-old absorbs can start a cascade in an eighty-year-old. Complications accumulate. Recovery is slower and less complete, and a fall often marks the point where independent living ends.

Johannigman is developing a geriatric injury program addressing prevention, treatment approach, and the complications that follow a fall in an older patient.

It is an unglamorous focus for a surgeon with eight combat tours behind him, and that is arguably the point. He has consistently gone after the failure that occurs most often rather than the one that sounds most dramatic. In this region, that failure happens on a staircase or a bathroom floor.

Readiness is a discipline, not a feeling

Johannigman’s current work in Cincinnati centers on the system rather than the case.

He leads joint training exercises that put UC Health trauma teams in the same room as firefighters, paramedics, and emergency management officials. The reasoning is direct. Groups who will have to coordinate during a disaster should learn each other’s language before one, not during.

He advocates for standardized protocols in the three areas that most often decide outcomes in the opening minutes after injury: massive hemorrhage control, rapid blood transfusion, and mass casualty triage. Each of those is a place where a delay of a few minutes changes the result, and each is a place where a decision made in advance beats a decision made under pressure.

He mentors surgeons through the American College of Surgeons, where he has served as State Chair for the Ohio Committee on Trauma and as Region Chief for the Committee on Trauma, and advises hospitals on preparedness planning for severe weather, active shooter incidents, and large-scale accidents.

He also speaks at community events, which may be the least expected part of the work. He walks residents through evacuation planning, blood donation, and how trauma systems actually function, on the reasoning that a prepared public is part of the system rather than an audience watching it.

The two worlds are one problem

The argument running through Johannigman’s career is that military and civilian trauma medicine are not adjacent fields. They solve the same problem under different constraints.

A system built to move a wounded soldier from a battlefield to definitive care is structurally the same system that moves a crash victim from a highway to a trauma bay. Both depend on coordination, on speed, and on teams that know their roles without being told. Both fail in the same places, and usually before the patient reaches the hospital.

What that means in practice is that readiness gets built on quiet days. It gets built in training exercises, protocol reviews, equipment checks, and the unremarkable work of confirming that what is supposed to be in place is actually in place.

Johannigman frames preparation as an act of optimism rather than fear. The goal is not to make people anxious about disaster. It is to make sure the capability exists on the day it is needed, so that a person facing the worst day of their life has the best available chance of getting through it.

The systems that make that true are boring to build.

They are the only thing that works.