U.S. Army Medical Department journal
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Uncontrolled hemorrhage remains the leading cause of potentially preventable death in combat casualties. In the current conflict, nearly two-thirds of these deaths occurred as a result of torso injuries with noncompressible hemorrhage and one-third from extremity injuries with compressible bleeding. ⋯ To provide combat medics with the best means of treating hemorrhages, it is essential to understand the mechanism of action, efficacy strength, and possible adverse effects of each available hemostatic agent. In this article, we review the risks and benefits of the agents/dressings that have been used on the battlefield, the process that led to the selection of the new agents, and the present deficiencies that must be addressed in the development of new products.
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Historically, hemorrhage accounts for the primary cause of death on the battlefield in conventional warfare. In addition, hemorrhage was associated with 85% of potentially survivable deaths in the current conflicts, approximately two-thirds of which were from noncompressible injuries. Future combat casualty care strategies suggest the likelihood of long transport times or significant time delays in evacuation of casualties. ⋯ Since the medic has few options for treating noncompressible injuries short of infusing fluid to maintain a blood pressure, the concept of damage control resuscitation was developed to promote hemostatic resuscitation. Damage control resuscitation recommends limiting the amount of crystalloids or colloids infused and using plasma and other blood products in more optimal ratios for the treatment of severe hemorrhage to improve battlefield survival and to reduce or prevent early and late deleterious sequelae. Taken together, these efforts have important implications towards the development of optimal fluid resuscitation strategies for stabilization of the combat casualty.
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Given the recent success of emergency tourniquets, limb exsanguination is no longer the most common cause of preventable death on the battlefield; hemorrhage amenable to truncal tourniquets now is. The purpose of the present study is to discuss the gaps today in battlefield hemorrhage control and candidate solutions in order to stimulate the advancement of prehospital combat casualty care. ⋯ In order to solve the now most common cause of preventable death on the battlefield, junctional hemorrhage from the pelvic area, the planned approach is a systematic review of research, device and model development, and the fielding of a good device with appropriate training and doctrine.
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Many combat-related deaths occur in the prehospital environment before the casualty reaches a medical treatment facility. The tenets of Tactical Combat Casualty Care (TCCC) were published in 1996 and integrated throughout the 75th Ranger Regiment in 1999. In order to validate and refine TCCC protocols and procedures, a prehospital trauma registry was developed and maintained. The application of TCCC, in conjunction with validation and refinement of TCCC through feedback from a prehospital trauma registry, has translated to an increase in survivability on the battlefield.