Since 2001, the CoTCCC has continued to monitor developments in prehospital trauma care. The TCCC Guidelines are updated based upon: (1) an ongoing review of the published civilian and military pre-hospital trauma literature; (2) ongoing interaction with military combat casualty care research laboratories; (3) direct input from experienced combat corpsmen, medics, and PJs; (4) input from the service medical Lessons Learned Centers; (5) case reports discussed at the weekly Joint Trauma System (JTS) process improvement video-teleconferences; (6) observations on the causes of death in combat fatalities gleaned from JTS-Armed Forces Medical Examiner System (AFMES) conferences; and (7) expert opinion from both military and civilian trauma experts.