Abstract: BACKGROUND: Conflicts related to Operation Iraqi Freedom (OIF) led to nearly 32,000 wounded U.S. service members, with thoracic injuries seen in 8.6% of casualties. Our aim was to better understand the effects of deployed cardiothoracic surgeons. METHODS: A retrospective analysis of DoD Trauma Registry data was performed. Inclusion criteria included U.S. service members with thoracic trauma that sought care at the role 3 hospital at Balad and received a cardiothoracic procedure from 2004 to 2011 during OIF. Deployment timelines were established to determine when a U.S. Air Force cardiothoracic surgeon was present at Balad. Patients that met inclusion criteria were divided 2 two cohorts based on the presence of a cardiothoracic surgeon. Clinical outcomes were assessed and compared between the 2 cohorts. RESULTS: One hundred and nine patients met inclusion criteria; 93.6% (n=102) of these patients were treated at Balad when a cardiothoracic surgeon was present and 6.4% (n=7) when a cardiothoracic surgeon was not present. Ninety-eight percent of all patients from both cohorts were male and the most common mechanism of injury was penetrating (58.7%, n=64). Average Injury Severity Score of patients when a cardiothoracic surgeon was present was 27.6 and when one was not was 29.4 (P-value .73). The most common injury observed between both cohorts was a pneumothorax and the most common thoracic procedure performed at Balad was bronchoscopy followed by chest tube placement. Mortality rate of 9.8% was observed in the cohort where a cardiothoracic surgeon was present and 14.3% in the cohort where a cardiothoracic surgeon was not present (P-value .70). CONCLUSIONS: A U.S. Air Force cardiothoracic surgeon was present at Balad for a large percentage of the time during OIF. The severity/distribution of patient injury and clinical outcomes appeared similar when a cardiothoracic surgeon was present/not present.