title: Potential value of protocols in substantially bleeding trauma patients.
abstract: OBJECTIVE
  Early identification of shock and coagulopathy coupled with damage control resuscitation are central tenets of early trauma management. In traumatic injury, haemorrhage is responsible for almost 50% of deaths occurring within the first 24 h of injury and up to 80% of intraoperative trauma mortalities. Immediate haemorrhagic mortality constitutes the largest group of potentially preventable deaths in the initial 24-h period. This review will discuss the recent changes and advancement of early traumatic coagulopathy and the important role of substantial bleeding protocols (SBPs).
  
  
  RESULTS
  Ho et al. examined survivor bias and determined when accounting for survivor bias improved survival outcome with higher fresh frozen plasma: red blood cell ratios. The PROMMTT study, a 10-centre observation trial, highlighted the variable nature of infusion, the importance of time and improved outcomes with higher product ratios.
  
  
  CONCLUSIONS
  An SBP addresses the organizational issues necessary to respond to massive blood loss in an immediate and sustained manner. It reduces provider variability, facilitates staff communication and compliance, and simplifies the administration of predefined ratios of blood components. A transfusion subcommittee should be formed to directly address the complex issues of implementing a SBP system.
authors: Division of Acute Care Surgery, Center for Translational Injury Research, University of Texas Health Science Center, Houston, Texas, USA. John.Holcomb@uth.tmc.edu
authors: John B
authors: JB
authors: Holcomb
authors: Sam
authors: S
authors: Gumbert
mesh_terms: D001778:Blood Coagulation Disorders / Q000628:therapy*; D001780:Blood Coagulation Tests; D002985:Clinical Protocols; D006470:Hemorrhage / Q000628:therapy*; D006801:Humans; D013916:Thrombelastography; D014148:Tranexamic Acid / Q000627:therapeutic use; D014947:Wounds and Injuries / Q000150:complications*
chemical_list: D014148:Tranexamic Acid