In a general civilian population, the in-hospital mortality in patients with ARDS remains upwards of 40%67 and the 5-year mortality is approximately 60%.68 For trauma patients, ARDS increases morbidity69 and may increase mortality as well,70 although there is some inconsistency in the current civilian literature.71 However, ARDS is an independent risk factor for death in combat casualties as noted above. To mitigate this risk, early LPV should be implemented along with minimizing unnecessary IV infusions, eliminating unnecessary blood product transfusions, and implementation of an aggressive physical therapy regimen if possible. Early activation of the ACCET evacuation system should also be considered.