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Tactical damage control resuscitation in austere military environments
  1. Yann Daniel1,
  2. S Habas1,
  3. L Malan1,
  4. J Escarment2,3,
  5. J-S David4,5 and
  6. S Peyrefitte1
  1. 1Antenne médicale spécialisée, Base des Fusiliers Marins et des Commandos, Lanester, France
  2. 2Hôpital d'Instruction des Armées Desgenettes, Lyon, France
  3. 3Direction Régionale du Service de Santé des Armées, Lyon, France
  4. 4Service d'Anesthésie Réanimation, Hôpital Edouard Herriot, Lyon, France
  5. 5Université Claude Bernard, Lyon, France
  1. Correspondence to Dr Yann Daniel MP, Base des Fusiliers Marins et des Commandos, Service Médical, Avenue Ingénieur Général Stosskopf, Lanester 56600, France; yadaniel{at}hotmail.fr

Abstract

Background Despite the early uses of tourniquets and haemostatic dressings, blood loss still accounts for the vast majority of preventable deaths on the battlefield. Over the last few years, progress has been made in the management of such injuries, especially with the use of damage control resuscitation concepts. The early application of these procedures, on the field, may constitute the best opportunity to improve survival from combat injury during remote operations.

Data sources Currently available literature relating to trauma-induced coagulopathy treatment and far-forward transfusion was identified by searches of electronic databases. The level of evidence and methodology of the research were reviewed for each article. The appropriateness for field utilisation of each medication was then discussed to take into account the characteristics of remote military operations.

Conclusions In tactical situations, in association with haemostatic procedures (tourniquet, suture, etc), tranexamic acid should be the first medication used according to the current guidelines. The use of fibrinogen concentrate should also be considered for patients in haemorrhagic shock, especially if point-of-care (POC) testing of haemostasis or shock severity is available. If POC evaluation is not available, it seems reasonable to still administer this treatment after clinical assessment, particularly if the evacuation is delayed. In this situation, lyophilised plasma may also be given as a resuscitation fluid while respecting permissive hypotension. Whole blood transfusion in the field deserves special attention. In addition to the aforementioned treatments, if the field care is prolonged, whole blood transfusion must be considered if it does not delay the evacuation.

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  • Received February 4, 2016.
  • Revision received June 30, 2016.
  • Accepted July 1, 2016.
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Footnotes

  • Contributors YD drafted the manuscript. YD, SH, LM and SP collected data and analysed them. JE, J-SD and SP critically revised the manuscript.

  • Competing interests J-SD did lectures for LFB Laboratory (Les Ullis, France).

  • Provenance and peer review Not commissioned; externally peer reviewed.

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