Col Valerie Sams, MD is an Air Force trauma surgeon, surgical critical care expert, and the Director of the Center for Sustainment of Trauma and Readiness Skills (C-STARS) at the University of Cincinnati. Her path to the operating room was anything but ordinary. Before medical school, she served as an Air Force line officer in logistics and fuels, learning how the operational side of the service actually works at the flight line. That bilingual fluency in operations and medicine now shapes how she advocates for resources, leads hospitals, and prepares the military health system for the next fight. In this conversation, she walks through her two tours as the trauma czar at the Bagram role three hospital straight out of fellowship, where she was responsible not only for clinical excellence but for leading every nurse, emergency medicine physician, and surgeon doing trauma care across the theater. She talks honestly about the weight of that role, especially during her second deployment with junior surgeons on their first downrange experience, the rise in U.S. casualties, the green-on-blue threat, and her work standing up Medic-X as a force multiplier for limited deployed medical crews. Col Sams makes a powerful case for the strategic importance of military-civilian partnerships like C-STARS, the only Air Force critical care air transport advanced training course, and explains how the Air Force, Army, and Navy are converging through the Joint Trauma System, the Mission Zero Act, and the American College of Surgeons Blue Book to professionalize military-civilian integration. She is direct about the skill sustainment crisis inside military treatment facilities, the shift from 65 percent beneficiary care to 20 percent, the urgency of the Military Unique Curriculum, and the need to train outside-the-tent skills deliberately rather than by accident. Dr. Sams lays out a clear-eyed vision for large-scale combat operations: faster trauma registry feedback loops, autonomous and decision support tools, closed-loop control ventilation, ECMO projected forward, and a hard end to the wax pencil and TCCC card as battlefield documentation. She closes with what should remain the center of gravity for every military medicine decision — the warfighter — and the conviction that they deserve the best clinical care available anywhere in the country. Chapters (00:47-05:47) From Fuels Officer to Trauma Surgeon (05:47-12:49) Two Tours as Trauma Czar at Bagram (12:49-24:46) ECMO Forward, C-STARS, and the Skill Sustainment Crisis (24:46-35:42) Joint Military-Civilian Integration and the Military Unique Curriculum (35:42-49:26) LSCO Readiness, Force Multiplication, and Battlefield Technology (49:26-58:30) Female Leadership, Clinical Excellence, and Legacy Chapter Summaries (00:47-05:47) From Fuels Officer to Trauma Surgeon Col Sams describes her unconventional path from Air Force line officer in logistics and fuels to general surgery and trauma fellowship. She credits her operational background with giving her a bilingual fluency between line and medical worlds that strengthens how she advocates for resources, leads hospital operations, and earns credibility with non-medical commanders. (05:47-12:49) Two Tours as Trauma Czar at Bagram She unpacks the weight of deploying as the trauma czar at the Bagram Role 3 immediately after her fellowship and the lessons that came from leading mass casualty events, debriefing young teams, and dealing with the green-on-blue threat. She explains the stand-up of Medic-X under Lt Gen Hogg as a deliberate force multiplier for limited deployed medical crews. (12:49-24:46) ECMO Forward, C-STARS, and the Skill Sustainment Crisis Col Sams details her work projecting ECMO capability into austere environments and around the globe, then explains the mission, history, and structure of the three original C-STARS programs. She is direct about the skill sustainment crisis, with beneficiary care in military treatment facilities dropping from roughly 65 percent to 20 percent over two decades. (24:46-35:42) Joint Military-Civilian Integration and the Military Unique Curriculum She describes the progress driven by the Mission Zero Act, the Joint Trauma System military-civilian work group, and the American College of Surgeons Blue Book. She makes the case for a robust Military Unique Curriculum that develops both surgical fundamentals and the outside-the-tent skills that today's young military surgeons need before they take their first leadership role downrange. (35:42-49:26) LSCO Readiness, Force Multiplication, and Battlefield Technology Col Sams turns to large-scale combat operations and the blind spots that the counterinsurgency generation may carry into the next fight. She calls for faster trauma registry feedback, autonomous decision support tools, closed-loop ventilation, ECMO projected forward, and a hard end to the TCCC wax pencil as the primary battlefield documentation tool. (49:26-58:30) Female Leadership, Clinical Excellence, and Legacy She offers candid advice to young female military surgeons on imposter syndrome, unconscious bias, and the discipline of staying clinically excellent. She closes with the conviction that patient-centered leadership, lifelong learning, and protecting clinical talent are the foundations of how military medicine should remember her work. Take Home Messages Operational Fluency Strengthens Medical Leadership: Time spent on the line side of the military — understanding logistics, fuels, and how the operational force actually fights — builds credibility with non-medical commanders and sharpens advocacy for resources. Surgeons who speak the operational language sit at the right tables and make better decisions for their teams and their patients. The Trauma Czar Role Demands Leadership Before Stride: Being responsible for an entire theater of combat casualty care immediately after fellowship is a heavy and unforgiving assignment. Clinical excellence is the floor; the real work is leading nurses, emergency medicine physicians, and surgeons through mass casualty events, debriefs, and the green-on-blue threat with junior teammates who have never deployed before. Skill Sustainment Requires Military-Civilian Partnership: Military treatment facilities now deliver only a fraction of the beneficiary care they once did, and that volume cannot sustain combat-ready trauma teams. Embedded military-civilian partnerships like C-STARS, supported by the Mission Zero Act and the American College of Surgeons Blue Book, are the realistic path to keep wartime skills sharp. Outside-the-Tent Skills Must Be Deliberately Trained: Today's young military surgeons need more than technical readiness. They need a deliberate Military Unique Curriculum that develops the non-clinical leadership skills required to run a theater trauma system, manage resources, and lead teams under pressure. Picking those skills up on the fly is no longer good enough. LSCO Will Not Wait on the Wax Pencil: The next fight will not give the medical force three years to figure out what changed or seven years to update clinical practice guidelines. Force multiplication through MedicX, autonomous decision support tools, closed-loop ventilation, ECMO projected forward, and modern battlefield documentation are non-negotiable investments now, before large-scale combat operations force the lesson. Col Valerie Sams, MD Biography Colonel Valerie Sams is the Director of the Center for Sustainment of Trauma and Readiness Skills (CSTARS) Cincinnati and serves as Critical Care Air Transport Team (CCAT) Training cadre. Originally from Georgetown, KY, she was commissioned into the Air Force in 2000, initially serving as a supply and logistics officer, which included a deployment supporting Stabilization Forces in the Balkans. Transitioning to medicine, she earned her medical degree from St. George’s University in 2008. Col Sams completed her General Surgery Residency at the University of Tennessee Medical Center (2013) and a Trauma Critical Care fellowship at Brooke Army Medical Center (2015). As a trauma surgeon and ECMO physician, Col Sams deployed twice as the Trauma Czar for Bagram Airfield, Afghanistan. Her extensive leadership roles include Trauma Medical Director, Assistant Chief of Trauma and Surgical Critical Care, Ground Surgical Team Pilot Unit Leader, and director of various military trauma research programs. Episode Keywords WarDocs, military medicine, military trauma surgery, combat casualty care, trauma czar, Bagram role three, Air Force trauma surgeon, C-STARS Cincinnati, critical care air transport, CCATT, Joint Trauma System, military civilian partnership, Mission Zero Act, military unique curriculum, large scale combat operations, LSCO, prolonged casualty care, MedicX, ECMO in combat, battlefield documentation, TCCC card, closed loop ventilation, military medical leadership Hashtags #MilitaryMedicine, #WarDocs, #CombatCasualtyCare, #TraumaSurgery, #JointTraumaSystem, #LSCOReadiness, #CSTARS, #MilCivPartnership Honoring the Legacy and Preserving the History of Military Medicine WarDocs exists to honor the legacy of Military Medicine, preserve its history, and inspire every generation — across all Services, Corps, and Ranks — to serve with excellence and pride. 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