title: Practical translation of hemorrhage control techniques to the civilian trauma scene.
abstract: This article examines how established and innovative techniques in hemorrhage control can be practically applied in a civilian physician-based prehospital trauma service. A "care bundle" of measures to control hemorrhage on scene are described. Interventions discussed include the implementation of a system to achieve simple endpoints such as shorter scene times, appropriate triage, careful patient handling, use of effective splints and measures to control external hemorrhage. More complex interventions include prehospital activation of massive hemorrhage protocols and administration of on-scene tranexamic acid, prothrombin complex concentrate, and red blood cells. Radical resuscitation interventions, such as prehospital thoracotomy for cardiac tamponade, and the potential future role of other interventions are also considered.
authors.affiliation: London's Air Ambulance, Royal London Hospital, London, UK. David.Lockey@nbt.nhs.uk
authors.forename: David J
authors.initials: DJ
authors.lastname: Lockey
authors.forename: Anne E
authors.initials: AE
authors.lastname: Weaver
authors.forename: Gareth E
authors.initials: GE
authors.lastname: Davies
mesh_terms: D001771:Blood Banks / Q000592:standards; D016913:Blood Component Transfusion / Q000379:methods* / Q000592:standards; D002305:Cardiac Tamponade / Q000601:surgery; D004632:Emergency Medical Services / Q000379:methods* / Q000592:standards; D006470:Hemorrhage / Q000628:therapy*; D006801:Humans; D008887:Military Medicine / Q000379:methods / Q000592:standards; D013908:Thoracotomy / Q000379:methods / Q000592:standards; D014947:Wounds and Injuries / Q000628:therapy*; D000094902:Blood Banking / Q000379:methods*