In planning for future contingencies, current problems often crowd out historical perspective and planners often turn to technological solutions to bridge gaps between desired outcomes and the reality of recent experience. The US Military, North Atlantic Treaty Organization, and other allies are collectively taking stock of 10-plus years of medical discovery and rediscovery of combat casualty care after the wars in Iraq and Afghanistan. There has been undeniable progress in the treatment of combat wounded during the course of the conflicts in Southwest Asia, but continued efforts are required to improve hemorrhage control and provide effective prehospital resuscitation that treats both coagulopathy and shock. This article presents an appraisal of the recent evolution in medical practice in historical context and suggests how further gains in far forward resuscitation might be achieved using existing technology and methods based on whole-blood transfusion while research on new approaches continues.
From the Coagulation Blood Research Program (A.P.C., H.F.P.), US Army Institute of Surgical Research, Fort Sam Houston, Houston, Texas; Deployment Medicine International (M.D.P.), Gig Harbor, Washington; Department of Surgery (J.F.R.), Temple University School of Medicine, Philadelphia, Pennsylvania; The Trauma & Combat Medicine Branch (E.G.), Surgeon General’s HW, Israel Defense Forces, Ramat Gan, Israel; Norwegian Naval Special Operations Commando (H.S.E., G.S.), Bergen, Norway; Department of Anaesthesia Intensive Care (C.K.B., T.K.F.), Haukeland University Hospital, Bergen, Norway; US Army Special Operations Command (S.K.), Fort Bragg, North Carolina; Advanced Tactical & Emergency Medicine (P.T.), United Kingdom; Department of Anesthesiology (R.S.), Division of Trauma Anesthesiology, Medical Director of Perfusion Cell Salvage Services, R. Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland; Ranger Regiment (E.M., A.F.), Fort Benning, Georgia; Department of Emergency Medicine (K.R.W.), University of Michigan, Michigan Center for Integrative Research in Critical Care, Ann Arbor, Michigan; Department of Pediatrics (P.C.S.), Division of Pediatric Critical Care, Washington University in St. Louis, St. Louis, Missouri; Department of Immunology Transfusion Medicine (G.S.), Haukeland University Hospital, Bergen, Norway.
Submitted: January 14, 2015, Accepted: February 2, 2015.
Address for reprints: Geir Strandenes, MD, Department of Immunology and Transfusion Medicine, Haukeland University Hospital and Norwegian Naval Special Operation, Bergen, Norway; email: firstname.lastname@example.org.