Optimizing trauma care delivery is paramount to saving lives on the battlefield. During the past decade of conflict, trauma care performance improvement at U.S. combat support hospitals and forward surgical teams in Afghanistan and Iraq has increased through Joint Trauma System and DoD Trauma Registry data collection, analysis, and rapid evidence-based adjustments to clinical practice guidelines. Although casualties have benefitted greatly from a trauma system and registry that improves hospital care, still lacking is a comprehensive and integrated system for data collection and analysis to improve performance at the prehospital level of care. Since 1996, Tactical Combat Casualty Care (TCCC) guidelines have become widely accepted in NATO as a standard of excellence for providing prehospital trauma care on the battlefield. In order to afford evidence-based adjustments to TCCC guidelines that will optimize prehospital trauma care delivery, TCCC based casualty cards, TCCC after action reports, and prehospital-based trauma registries need to be implemented globally and linked to hospital-based registries as well as casualty morbidity and mortality outcomes.