Hemorrhage remains the primary cause of preventable death on the battlefield and in civilian trauma. Hemorrhage control is multifactorial and starts with point-of-injury care. Surgical hemorrhage control and time from injury to surgery is paramount; however, interventions in the prehospital environment and perioperative period affect outcomes. The purpose of this review is to understand concepts and strategies for successful management of the bleeding military patient. Understanding the life-threatening nature of coagulopathy of trauma and implementing strategies aimed at full spectrum hemorrhage management from point of injury to postoperative care will result in improved outcomes in patients with life-threatening bleeding.
Timely and appropriate therapies impact survival. Blood product resuscitation for life-threatening hemorrhage should either be with whole blood or a component therapy strategy that recapitulates the functionality of whole blood. The US military has transfused over 10 000 units of whole blood since the beginning of the wars in Iraq and Afghanistan. The well recognized therapeutic benefits of whole blood have pushed this therapy far forward into prehospital care in both US and international military forces. Multiple hemostatic adjuncts are available that are likely beneficial to the bleeding military patient; and other products and techniques are under active investigation.
Lessons learned in the treatment of combat casualties will likely continue to have positive impact and influence and the management of hemorrhage in the civilian trauma setting.
aUniformed Services University of Health Sciences, Bethesda, Maryland
bU.S. Army Institute of Surgical Research, JBSA-FT Sam, Houston, Texas
cDivision of Critical Care, Department of Pediatrics, Washington University in St Louis School of Medicine, St. Louis, Missouri, USA
Correspondence to Philip C. Spinella, MD, FCCM, Director, Pediatric Critical Care Translational Research Program, Professor, Department of Pediatrics, Washington University in St Louis School of Medicine, Campus Box 8116, One Children's Place, Northwest Tower 10th Floor, St Louis, MO 63110, USA. Tel: +1 314 286 0858; fax: +1 210 8963462; e-mail: email@example.com