Many efforts in the pre-hospital combat environment had been aimed at prolonging the viability of a patient until they are able to make it to a surgeon. The goal of military triage and evacuation is to have urgent surgical patients to a waiting surgical team within 2 hours. Despite our best efforts, this is not always possible. When it is not possible, it is important to do the simple interventions which we know make a difference for combat casualties such as tourniquets, wound packing, needle decompression, airway adjuncts and pelvic binding. Wounds causing non-compressible hemorrhage to the torso need additional strategies to bridge the time and space gap to definitive treatment. A non-surgical adjunct which has shown much promise has been the early transfusion of whole blood and blood products until surgical care can be provided. Our newest Clinical Practice Guideline on Remote Damage Control Resuscitation details what should be done and why.
There is an entirely separate working group, The Tactical Hemostasis, Oxygenation and Resuscitation (THOR) group dedicated to exactly those principles which we partnered with early on to help identify solutions dealing with hemorrhagic shock. Despite all that effort and brain power however, blood remains a finite resource in the austere environment and Medics have faced terrible situations where even blood administration is not enough and surgery is too far away. It is in these times of worst-case desperation that we want to do more for our patients. Some of the adjuncts discussed in this episode are abdominal tourniquets, REBOA and open surgical procedures. We don’t take any of this lightly and realize that for the vast majority of our pre-hospital audience, many of the procedures discussed are far outside the current scope of practice.
What is possible?
What is responsible?
What is sustainable?
Enjoy the talk.