The unique settings of the war zone or confrontation with a biological weapon create dynamic and potentially formidable barriers to individual and trauma team performance. Patient care in war zones is challenged by limited resources, threats of combat, and variable team member composition. Biological weapons create unique challenges to trauma team performance and care delivery by demanding recognition and identification, personal protection, decontamination, and specific treatment. Thoughtful appreciation of the obstacles arising in these circumstances can prepare the trauma provider and the trauma team to optimize their delivery of patient care.