Skip to main content

Advertisement

SpringerLink
Log in

Alone and Sometimes Unafraid: Military Perspective on Forward Damage Control Resuscitation on the Modern Battlefield

  • The Military Perspective (MJ Martin and M Schreiber, Section Editors)
  • Published:
Current Trauma Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

The objective of this review is to describe the military experience and utilization of damage control resuscitation as well as explore future developments to push the best medicine far forward in the austere environment.

Recent Findings

The Global War on Terror has transitioned from mature combat theaters staged with rapid medical evacuation and robust medical facilities to more austere environments. Due to this transition, the military medical force has adopted the practice of sending providers and surgeons into forward deployed environments to provide Damage Control Resuscitation closer to the point of injury.

Summary

This review focuses on the key tenets of Damage Control Resuscitation and its development. It also describes how various military units have adopted damage control resuscitation principles.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Eastridge BJ, Mabry RL, Seguin P, Cantrell J, Tops T, Uribe P, et al. Death on the battlefield (2001-2011): implications for the future of combat casualty care. J Trauma. 2012;73(6, Supplement 5):S431–S7.

    Article  Google Scholar 

  2. •• Cap AP, Pidcoke HF, Spinella P, Strandenes G, Borgman MA, Schreiber M, et al. This manuscript serves as a comprehensive resource for DCR principles from the point of injury to medical treatment facilities. Damage Control Resuscitation Mil Med. 2018;183(suppl_2):36–43. https://doi.org/10.1093/milmed/usy112.

    Article  PubMed  Google Scholar 

  3. Holcomb JB, Jenkins D, Rhee P, Johannigman J, Mahoney P, Mehta S, et al. Damage control resuscitation: directly addressing the early coagulopathy of trauma. J Trauma. 2007;62(2):307–10. https://doi.org/10.1097/TA.0b013e3180324124.

    Article  PubMed  Google Scholar 

  4. Roberts I, Perel P, Prieto-Merino D, Shakur H, Coats T, Hunt BJ, et al. Effect of tranexamic acid on mortality in patients with traumatic bleeding: prespecified analysis of data from randomised controlled trial. BMJ (Clinical research ed). 2012;345:e5839. https://doi.org/10.1136/bmj.e5839.

    Article  Google Scholar 

  5. Pidcoke HF, Aden JK, Mora AG, Borgman MA, Spinella PC, Dubick MA, et al. Ten-year analysis of transfusion in Operation Iraqi Freedom and Operation Enduring Freedom: increased plasma and platelet use correlates with improved survival. J Trauma Acute Care Surg. 2012;73(6 Suppl 5):S445–52. https://doi.org/10.1097/TA.0b013e3182754796.

    Article  PubMed  Google Scholar 

  6. Borgman MA, Spinella PC, Perkins JG, Grathwohl KW, Repine T, Beekley AC, et al. The ratio of blood products transfused affects mortality in patients receiving massive transfusions at a combat support hospital. J Trauma. 2007;63(4):805–13. https://doi.org/10.1097/TA.0b013e3181271ba3.

    Article  PubMed  Google Scholar 

  7. •• Holcomb JB, Zarzabal LA, Michalek JE, Kozar RA, Spinella PC, Perkins JG, et al. Increased platelet: RBC ratios are associated with improved survival after massive transfusion. J Trauma. 2011;71(2 Suppl 3):S318–28. https://doi.org/10.1097/TA.0b013e318227edbb. Important paper on massive transfusion strategies and outcomes.

    Article  PubMed  Google Scholar 

  8. Shaz BH, Dente CJ, Nicholas J, MacLeod JB, Young AN, Easley K, et al. Increased number of coagulation products in relationship to red blood cell products transfused improves mortality in trauma patients. Transfusion. 2010;50(2):493–500. https://doi.org/10.1111/j.1537-2995.2009.02414.x.

    Article  CAS  PubMed  Google Scholar 

  9. Stinger HK, Spinella PC, Perkins JG, Grathwohl KW, Salinas J, Martini WZ, et al. The ratio of fibrinogen to red cells transfused affects survival in casualties receiving massive transfusions at an army combat support hospital. J Trauma. 2008;64(2 Suppl):S79–85; discussion S. https://doi.org/10.1097/TA.0b013e318160a57b.

    Article  CAS  PubMed  Google Scholar 

  10. •• Holcomb JB, Tilley BC, Baraniuk S, Fox EE, Wade CE, Podbielski JM, et al. Transfusion of plasma, platelets, and red blood cells in a 1:1:1 vs a 1:1:2 ratio and mortality in patients with severe trauma: the PROPPR randomized clinical trial. JAMA. 2015;313(5):471–82. https://doi.org/10.1001/jama.2015.12Landmark paper on 1:1:1 component therapy and its effects on traumatic resuscitation.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. • Blackbourne LH, Baer DG, Eastridge BJ, Kheirabadi B, Bagley S, Kragh JF Jr, et al. Military medical revolution: prehospital combat casualty care. J Trauma Acute Care Surg. 2012;73(6 Suppl 5):S372–7. https://doi.org/10.1097/TA.0b013e3182755662Importance of how military medicine must also evolve like revolutions in military affairs in order for military medicine to save lives and stay relevant.

    Article  PubMed  Google Scholar 

  12. Kragh JF Jr, Walters TJ, Baer DG, Fox CJ, Wade CE, Salinas J, et al. Practical use of emergency tourniquets to stop bleeding in major limb trauma. J Trauma. 2008;64(2 Suppl):S38–49; discussion S-50. https://doi.org/10.1097/TA.0b013e31816086b1.

    Article  PubMed  Google Scholar 

  13. Kelly JF, Ritenour AE, McLaughlin DF, Bagg KA, Apodaca AN, Mallak CT, et al. Injury severity and causes of death from Operation Iraqi Freedom and Operation Enduring Freedom: 2003-2004 versus 2006. J Trauma. 2008;64(2 Suppl):S21–6. https://doi.org/10.1097/TA.0b013e318160b9fb.

    Article  PubMed  Google Scholar 

  14. Kragh JF Jr, Walters TJ, Westmoreland T, Miller RM, Mabry RL, Kotwal RS, et al. Tragedy into drama: an american history of tourniquet use in the current war. J Spec Oper Med. 2013;13(3):5–25.

    PubMed  Google Scholar 

  15. 2018. 1322.24 DoDI. Military rReadiness tTraining. In: Pentagon T, editor. Washington, D.C.: The Pentagon.

  16. Butler FK. Two decades of saving lives on the battlefield: tactical combat casualty care turns 20. Mil Med. 2017;182(3):e1563–e8. https://doi.org/10.7205/MILMED-D-16-00214.

    Article  PubMed  Google Scholar 

  17. Kotwal RS, Butler FK, Gross KR, Kheirabadi BS, Baer DG, Dubick MA, et al. Management of junctional hemorrhage in tactical combat casualty care: TCCC guidelines? Proposed change 13-03. J Special Oper Med : a peer reviewed journal for SOF medical professionals. 2013;13(4):85–93.

    Google Scholar 

  18. Bennett BL, Littlejohn LF, Kheirabadi BS, Butler FK, Kotwal RS, Dubick MA, et al. Management of external hemorrhage in tactical combat casualty care: chitosan-based hemostatic gauze dressings--TCCC guidelines-change 13-05. J Special Oper Med : a peer reviewed journal for SOF medical professionals. 2014;14(3):40–57.

    Google Scholar 

  19. • Chang R, Eastridge BJ, Holcomb JB. Remote damage control resuscitation in austere environments. Wilderness Environ Med. 2017;28(2s):S124–s34. https://doi.org/10.1016/j.wem.2017.02.002A paper that translates the challenges of doing DCR in a remote and austere setting.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Schauer SG, April MD, Naylor JF, Fisher AD, Cunningham CW, Ryan KL, et al. QuikClot™ combat gauze use by ground forces in Afghanistan. J Spec Oper Med. 2017;17(2):100–5.

    Google Scholar 

  21. Schauer SG, April MD, Naylor JF, Maddry JK, Arana AA, Dubick MA, et al. Prehospital application of hemostatic agents in Iraq and Afghanistan. Prehospital Emergency Care. 2018;22:1–10. https://doi.org/10.1080/10903127.2017.1423140.

    Article  Google Scholar 

  22. Lyon M, Shiver SA, Greenfield EM, Reynolds BZ, Lerner EB, Wedmore IS, et al. Use of a novel abdominal aortic tourniquet to reduce or eliminate flow in the common femoral artery in human subjects. J Trauma Acute Care Surg. 2012;73(2 Suppl 1):S103–5. https://doi.org/10.1097/TA.0b013e3182606219.

    Article  PubMed  Google Scholar 

  23. Cantle PM, Hurley MJ, Swartz MD, Holcomb JB. Methods for early control of abdominal hemorrhage: an assessment of potential benefit. J Spec Oper Med. 2018;18(2):98–104.

    PubMed  Google Scholar 

  24. Mueller GR, Pineda TJ, Xie HX, Teach JS, Barofsky AD, Schmid JR, et al. A novel sponge-based wound stasis dressing to treat lethal noncompressible hemorrhage. J Trauma Acute Care Surg. 2012;73(2 Suppl 1):S134–9. https://doi.org/10.1097/TA.0b013e3182617c3c.

    Article  CAS  PubMed  Google Scholar 

  25. Rago AP, Duggan MJ, Beagle J, Peev MP, Marini J, Hwabejire JO, et al. Self-expanding foam for prehospital treatment of intra-abdominal hemorrhage: 28-day survival and safety. J Trauma Acute Care Surg. 2014;77(3 Suppl 2):S127–33. https://doi.org/10.1097/ta.0000000000000380.

    Article  CAS  PubMed  Google Scholar 

  26. Rago AP, Duggan MJ, Hannett P, Brennecke LH, La Rochelle A, Khatri C, et al. Chronic safety assessment of hemostatic self-expanding foam: 90-day survival study and intramuscular biocompatibility. J Trauma Acute Care Surg. 2015;79(4 Suppl 2):S78–84. https://doi.org/10.1097/ta.0000000000000571.

    Article  CAS  PubMed  Google Scholar 

  27. Moore LJ, Brenner M, Kozar RA, Pasley J, Wade CE, Baraniuk MS, et al. Implementation of resuscitative endovascular balloon occlusion of the aorta as an alternative to resuscitative thoracotomy for noncompressible truncal hemorrhage. J Trauma Acute Care Surg. 2015;79(4):523–30; discussion 30-2. https://doi.org/10.1097/TA.0000000000000809.

    Article  PubMed  Google Scholar 

  28. Du Bose JJ, Scalea TM, Brenner M, Skiada D, Inaba K, Cannon J, et al. The AAST prospective Aortic Occlusion for Resuscitation in Trauma and Acute Care Surgery (AORTA) registry: data on contemporary utilization and outcomes of aortic occlusion and resuscitative balloon occlusion of the aorta (REBOA). J Trauma Acute Care Surg. 2016;81(3):409–19. https://doi.org/10.1097/ta.0000000000001079.

    Article  Google Scholar 

  29. Chaudery M, Clark J, Morrison JJ, Wilson MH, Bew D, Darzi A. Can contrast-enhanced ultrasonography improve zone III REBOA placement for prehospital care? J Trauma Acute Care Surg. 2016;80(1):89–94. https://doi.org/10.1097/ta.0000000000000863.

    Article  PubMed  Google Scholar 

  30. Russo RM, Williams TK, Grayson JK, Lamb CM, Cannon JW, Clement NF, et al. Extending the golden hour: partial resuscitative endovascular balloon occlusion of the aorta in a highly lethal swine liver injury model. J Trauma Acute Care Surg. 2016;80(3):372–8; discussion 8-80. https://doi.org/10.1097/ta.0000000000000940.

    Article  PubMed  Google Scholar 

  31. • Joseph B, Zeeshan M, Sakran JV, Hamidi M, Kulvatunyou N, Khan M et al. Nationwide Analysis of Resuscitative Endovascular Balloon Occlusion of the Aorta in Civilian Trauma. JAMA Surgery. 2019. doi:https://doi.org/10.1001/jamasurg.2019.0096. An important but controversial study. Do sicker patients get REBOA? A study which highlights the needs for greater research on the use of REBOA. An area of constant discussion and consternation

    Article  PubMed  PubMed Central  Google Scholar 

  32. •• Manley JD, Mitchell BJ, DuBose JJ, Rasmussen TE. A modern case series of resuscitative endovascular balloon occlusion of the aorta (REBOA) in an out-of-hospital, combat casualty care setting. J Special Oper Med : a peer reviewed journal for SOF medical professionals. 2017;17(1):1–8. A limited case series on the use of REBOA by a small US Air Force Special Operations DCS team.

    Google Scholar 

  33. Fisher AD, Miles EA, Cap AP, Strandenes G, Kane SF. Tactical damage control resuscitation. Mil Med. 2015;180(8):869–75. https://doi.org/10.7205/MILMED-D-14-00721.

    Article  PubMed  Google Scholar 

  34. Pidcoke HF, Spinella PC, Ramasubramanian AK, Strandenes G, Hervig T, Ness PM, et al. Refrigerated platelets for the treatment of acute bleeding: a review of the literature and reexamination of current standards. Shock (Augusta, Ga). 2014;41(Suppl 1):51–3. https://doi.org/10.1097/shk.0000000000000078.

    Article  Google Scholar 

  35. Cap AP, Spinella PC, Borgman MA, Blackbourne LH, Perkins JG. Timing and location of blood product transfusion and outcomes in massively transfused combat casualties. J Trauma Acute Care Surg. 2012;73(2 Suppl 1):S89–94. https://doi.org/10.1097/TA.0b013e318260625a.

    Article  PubMed  Google Scholar 

  36. Perkins JG, Cap AP, Spinella PC, Blackbourne LH, Grathwohl KW, Repine TB, et al. An evaluation of the impact of apheresis platelets used in the setting of massively transfused trauma patients. J Trauma. 2009;66(4 Suppl):S77–84; discussion S-5. https://doi.org/10.1097/TA.0b013e31819d8936.

    Article  PubMed  Google Scholar 

  37. Reddoch KM, Pidcoke HF, Montgomery RK, Fedyk CG, Aden JK, Ramasubramanian AK, et al. Hemostatic function of apheresis platelets stored at 4 degrees C and 22 degrees C. Shock (Augusta, Ga). 2014;41(Suppl 1):54–61. https://doi.org/10.1097/shk.0000000000000082.

    Article  Google Scholar 

  38. Nair PM, Pidcoke HF, Cap AP, Ramasubramanian AK. Effect of cold storage on shear-induced platelet aggregation and clot strength. J Trauma Acute Care Surg. 2014;77(3 Suppl 2):S88–93. https://doi.org/10.1097/ta.0000000000000327.

    Article  PubMed  Google Scholar 

  39. Perkins JG, Cap AP, Spinella PC, Shorr AF, Beekley AC, Grathwohl KW, et al. Comparison of platelet transfusion as fresh whole blood versus apheresis platelets for massively transfused combat trauma patients (CME). Transfusion. 2011;51(2):242–52. https://doi.org/10.1111/j.1537-2995.2010.02818.x.

    Article  PubMed  Google Scholar 

  40. Spinella PC, Dunne J, Beilman GJ, O'Connell RJ, Borgman MA, Cap AP, et al. Constant challenges and evolution of US military transfusion medicine and blood operations in combat. Transfusion. 2012;52(5):1146–53. https://doi.org/10.1111/j.1537-2995.2012.03594.x.

    Article  PubMed  Google Scholar 

  41. Spinella PC, Perkins JG, Grathwohl KW, Beekley AC, Holcomb JB. Warm fresh whole blood is independently associated with improved survival for patients with combat-related traumatic injuries. J Trauma. 2009;66(4 Suppl):S69–76. https://doi.org/10.1097/TA.0b013e31819d85fb.

    Article  PubMed  PubMed Central  Google Scholar 

  42. •• Strandenes G, Berseus O, Cap AP, Hervig T, Reade M, Prat N, et al. Low titer group O whole blood in emergency situations. Shock. 2014;41(Suppl 1):70–5. https://doi.org/10.1097/SHK.0000000000000150A Norwegian protocol which led the way for the use of low titer group O whole blood.

    Article  PubMed  Google Scholar 

  43. Simmons JW, White CE, Eastridge BJ, Mace JE, Wade CE, Blackbourne LH. Impact of policy change on US Army combat transfusion practices. J Trauma. 2010;69(Suppl 1):S75–80. https://doi.org/10.1097/TA.0b013e3181e44952.

    Article  PubMed  Google Scholar 

  44. Jobes D, Wolfe Y, O'Neill D, Calder J, Jones L, Sesok-Pizzini D, et al. Toward a definition of “fresh” whole blood: an in vitro characterization of coagulation properties in refrigerated whole blood for transfusion. Transfusion. 2011;51(1):43–51. https://doi.org/10.1111/j.1537-2995.2010.02772.x.

    Article  CAS  PubMed  Google Scholar 

  45. Pidcoke HF, McFaul SJ, Ramasubramanian AK, Parida BK, Mora AG, Fedyk CG, et al. Primary hemostatic capacity of whole blood: a comprehensive analysis of pathogen reduction and refrigeration effects over time. Transfusion. 2013;53(Suppl 1):137S–49S. https://doi.org/10.1111/trf.12048.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  46. Strandenes G, Austlid I, Apelseth TO, Hervig TA, Sommerfelt-Pettersen J, Herzig MC, et al. Coagulation function of stored whole blood is preserved for 14 days in austere conditions: a ROTEM feasibility study during a Norwegian antipiracy mission and comparison to equal ratio reconstituted blood. J Trauma Acute Care Surg. 2015;78(6 Suppl 1):S31–8. https://doi.org/10.1097/ta.0000000000000628.

    Article  PubMed  Google Scholar 

  47. •• Shakur H, Roberts I, Bautista R, Caballero J, Coats T, Dewan Y, et al. Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomised, placebo-controlled trial. Lancet (London, England). 2010;376(9734):23–32. https://doi.org/10.1016/s0140-6736(10)60835-5A landmark trial highlighting the promise and controversy of TXA use in trauma.

    Article  CAS  Google Scholar 

  48. Morrison JJ, Dubose JJ, Rasmussen TE, Midwinter MJ. Military application of tranexamic acid in trauma emergency resuscitation (MATTERs) study. Arch Surg. 2012;147(2):113–9. https://doi.org/10.1001/archsurg.2011.287.

    Article  CAS  PubMed  Google Scholar 

  49. • Johnston LR, Rodriguez CJ, Elster EA, Bradley MJ. Evaluation of military use of tranexamic acid and associated thromboembolic events. JAMA Surg. 2018;153(2):169–75. https://doi.org/10.1001/jamasurg.2017.3821Recent study of US casualties in Afghanistan who received TXA and their elevated risk for VTE. This study highlights that the controversy surrounding TXA is not yet over.

    Article  PubMed  Google Scholar 

  50. Howard JT, Stockinger ZT, Cap AP, Bailey JA, Gross KR. Military use of tranexamic acid in combat trauma. J Trauma Acute Care Surg. 2017;83(4):579–88. https://doi.org/10.1097/ta.0000000000001613.

    Article  CAS  PubMed  Google Scholar 

  51. Boffard KD, Riou B, Warren B, Choong PI, Rizoli S, Rossaint R, et al. Recombinant factor VIIa as adjunctive therapy for bleeding control in severely injured trauma patients: two parallel randomized, placebo-controlled, double-blind clinical trials. J Trauma. 2005;59(1):8–15 discussion -8.

    Article  CAS  PubMed  Google Scholar 

  52. Roberts I, Prieto-Merino D, Manno D. Mechanism of action of tranexamic acid in bleeding trauma patients: an exploratory analysis of data from the CRASH-2 trial. Crit Care. 2014;18(6):685.

    Article  PubMed  PubMed Central  Google Scholar 

  53. Roberts I, Shakur H, Afolabi A, Brohi K, Coats T, Dewan Y, et al. The importance of early treatment with tranexamic acid in bleeding trauma patients: an exploratory analysis of the CRASH-2 randomised controlled trial. Lancet (London, England). 2011;377(9771):1096–101, 101.e1–2. https://doi.org/10.1016/s0140-6736(11)60278-x.

    Article  CAS  Google Scholar 

  54. Dutton RP, McCunn M, Hyder M, D'Angelo M, O'Connor J, Hess JR, et al. Factor VIIa for correction of traumatic coagulopathy. J Trauma. 2004;57(4):709–18 discussion 18-9.

    Article  CAS  PubMed  Google Scholar 

  55. Collins PW, Solomon C, Sutor K, Crispin D, Hochleitner G, Rizoli S, et al. Theoretical modelling of fibrinogen supplementation with therapeutic plasma, cryoprecipitate, or fibrinogen concentrate. Br J Anaesth. 2014;113(4):585–95. https://doi.org/10.1093/bja/aeu086.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  56. Schlimp CJ, Schochl H. The role of fibrinogen in trauma-induced coagulopathy. Hamostaseologie. 2014;34(1):29–39. https://doi.org/10.5482/hamo-13-07-0038.

    Article  CAS  PubMed  Google Scholar 

  57. Schochl H, Schlimp CJ, Maegele M. Tranexamic acid, fibrinogen concentrate, and prothrombin complex concentrate: data to support prehospital use? Shock (Augusta, Ga). 2014;41(Suppl 1):44–6. https://doi.org/10.1097/shk.0000000000000093.

    Article  Google Scholar 

  58. Eddy VA, Morris JA Jr, Cullinane DC. Hypothermia, coagulopathy, and acidosis. Surg Clin North Am. 2000;80(3):845–54.

    Article  CAS  PubMed  Google Scholar 

  59. Garcia GD, Modesto VL, Lee KT. Avoiding hypothermia in trauma: use of the flameless heater pack, meal ready to eat, as a field-expedient means of warming crystalloid fluid. Mil Med. 2000;165(12):903–4.

    Article  CAS  PubMed  Google Scholar 

  60. Gentilello LM, Jurkovich GJ, Stark MS, Hassantash SA, O'Keefe GE. Is hypothermia in the victim of major trauma protective or harmful? A randomized, prospective study. Ann Surg. 1997;226(4):439–47 discussion 47-9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  61. Peng RY, Bongard FS. Hypothermia in trauma patients. J Am Coll Surg. 1999;188(6):685–96.

    Article  CAS  PubMed  Google Scholar 

  62. Wade CE, Salinas J, Eastridge BJ, McManus JG, Holcomb JB. Admission hypo- or hyperthermia and survival after trauma in civilian and military environments. Int J Emerg Med. 2011;4(1):35. https://doi.org/10.1186/1865-1380-4-35.

    Article  PubMed  PubMed Central  Google Scholar 

  63. Allen PB, Salyer SW, Dubick MA, Holcomb JB, Blackbourne LH. Preventing hypothermia: comparison of current devices used by the US Army in an in vitro warmed fluid model. J Trauma. 2010;69(Suppl 1):S154–61. https://doi.org/10.1097/TA.0b013e3181e45ba5.

    Article  PubMed  Google Scholar 

  64. Calderbank P, Woolley T, Mercer S, Schrager J, Kazel M, Bree S, et al. Doctor on board? What is the optimal skill-mix in military pre-hospital care? Emerg Med J : EMJ. 2011;28(10):882–3. https://doi.org/10.1136/emj.2010.097642.

    Article  PubMed  Google Scholar 

  65. Kotwal RS, Montgomery HR, Miles EA, Conklin CC, Hall MT, McChrystal SA. Leadership and a casualty response system for eliminating preventable death. J Trauma Acute Care Surg. 2017;82(Supp 1:S9–S15.

    Article  PubMed  Google Scholar 

  66. Kotwal RS, Montgomery HR, Kotwal BM, Champion HR, Butler FK Jr, Mabry RL, et al. Eliminating preventable death on the battlefield. Arch Surg. 2011;146(12):1350–8. https://doi.org/10.1001/archsurg.2011.213.

    Article  PubMed  Google Scholar 

  67. Kendrick DB. Blood program in world war. II ed. Washington, D.C.: Office of the Surgeon General; 1964.

    Google Scholar 

  68. Warner N, Zheng J, Nix G, Fisher AD, Johnson JC, Williams JE, et al. Prehospital use of group O low titre whole blood. J Spec Oper Med. 2018;18(1):15–8.

    PubMed  Google Scholar 

  69. Riesberg J. The special operations resuscitation team: robust role II medical support for today’s SOF environment. J Special Oper Med : a peer reviewed journal for SOF medical professionals. 2009;9(1):27–32.

    Google Scholar 

  70. • Manley J, Le AT, Nam JJ. A case report of simultaneous hypotensive patients managed with concurrent REBOA in a single-surgeon, austere combat casualty environment. J Endovasc Resuscitation Trauma Manag 2018;2(2). This case report demonstrates the utility of REBOA in the far forward, resource and surgeon limited setting with good patient outcomes.

  71. • Baker JB, Modlin RE, Ong RC, Remick KN. The SOF truths for army Special Operations Forces surgical teams. J Special Oper Med: a peer reviewed journal for SOF medical professionals. 17(4):52–5 This policy paper highlights the need for Army Special Operations to field their own surgical teams. This concept is currently being employed by the conventional US Army as well to have more mobile and expeditionary resuscitative and surgical teams.

  72. Butler FK Jr, Holcomb JB, Shackelford S, Barbabella S, Bailey JA, Baker JB, et al. Advanced resuscitative care in tactical combat casualty care: TCCC guidelines change 18–01:14 October 2018. J Special Oper Med : a peer reviewed journal for SOF medical professionals. 18(4):37–55.

  73. • Lyon RF, Northern DM. REBOA by a non-surgeon as an adjunct during MASCAL. Am J Emerg Med. 2018;36(6):1121.e5–6. https://doi.org/10.1016/j.ajem.2018.02.013. This case report demonstrates the ability for non-surgeon providers to successfully deploy REBOA when a surgeon is not immediately available.

    Article  Google Scholar 

  74. Ross EM, Redman TT. Feasibility and proposed training pathway for austere application of resuscitative balloon occlusion of the aorta. J Spec Oper Med. 2018;18(1):37–43.

    PubMed  Google Scholar 

  75. •• Fisher AD, Washbum G, Powell D, Callaway DW, Miles EA, Brown J, et al. Damage control resuscitation in prolonged field care. J Spec Oper Med. 2018;18(3):109–19 This is clinical practice guideline was designed to improve the implementation of DCR principles in the PFC environment.

    PubMed  Google Scholar 

  76. Nessen SC, Eastridge BJ, Cronk D, Craig RM, Berséus O, Ellison R, et al. Fresh whole blood use by forward surgical teams in Afghanistan is associated with improved survival compared to component therapy without platelets. Transfusion. 2013;53:107S–13S. https://doi.org/10.1111/trf.12044.

    Article  PubMed  Google Scholar 

  77. Repine TB, Perkins JG, Kauvar DS, Blackborne L. The use of fresh whole blood in massive transfusion. J Trauma. 2006;60(6 Suppl):S59–69. https://doi.org/10.1097/01.ta.0000219013.64168.b2.

    Article  PubMed  Google Scholar 

  78. Doughty H, Thompson P, Cap AP, Spinella PC, Glassberg E, Skogrand Eliassen H, et al. A proposed field emergency donor panel questionnaire and triage tool. Transfusion. 2016;56(Suppl 2):S119–27. https://doi.org/10.1111/trf.13487.

    Article  PubMed  Google Scholar 

  79. Kuckelman JP, Barron M, Moe D, Derickson M, Phillips C, Kononchik J, et al. Extending the golden hour for zone 1 resuscitative endovascular balloon occlusion of the aorta. J Trauma Acute Care Surg. 2018;85(2):318–26. https://doi.org/10.1097/ta.0000000000001964.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. US Army Special Operations Command, 528th Sustainment Brigade (SO) (A), BLDG X4047 New Dawn Drive, Fort Bragg, NC, 28310, USA

    Jason J. Nam

  2. Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA

    Jason J. Nam & Robert D. McLeroy

  3. Department of Medicine, Division of Pulmonary and Critical Care, Walter Reed National Military Medical Center, Bethesda, MD, USA

    Robert D. McLeroy

  4. Texas A&M College of Medicine, Temple, TX, USA

    Andrew D. Fisher

  5. Medical Command, Texas Army National Guard, Austin, TX, USA

    Andrew D. Fisher

  6. Prehospital Research in Military and Expeditionary Environments (PRIME2), San Antonio, TX, USA

    Andrew D. Fisher

Authors
  1. Jason J. Nam
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Robert D. McLeroy
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Andrew D. Fisher
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jason J. Nam.

Ethics declarations

Conflicts of Interest

Dr. Nam has nothing to disclose. Dr. McLeroy has nothing to disclose. Dr. Fisher received reimbursement from Prytime Medical for overnight accommodations for the RAPToR course on 28–29 November 2018. Dr. Fisher has nothing else to disclose.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Department of Defense Disclaimer

The views expressed herein are those of the authors and do not reflect the official policy or position of the US Army Medical Department, the US Army Office of the Surgeon General, the Department of the Army, the Department of Defense, or the US Government.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on The Military Perspective

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Nam, J.J., McLeroy, R.D. & Fisher, A.D. Alone and Sometimes Unafraid: Military Perspective on Forward Damage Control Resuscitation on the Modern Battlefield. Curr Trauma Rep 5, 119–128 (2019). https://doi.org/10.1007/s40719-019-00173-7

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40719-019-00173-7

Keywords

Search

Navigation