title: Implementation and execution of civilian remote damage control resuscitation programs.
abstract: Remote damage control resuscitation is a recently defined term used to describe techniques and strategies to provide hemostatic resuscitation to injured patients in the prehospital setting. In the civilian setting, unlike the typical military setting, patients who require treatment for hemorrhage come in all ages with all types of comorbidities and have bleeding that may be non-trauma related. Thus, in the austere setting, addressing the needs of the patient is no less challenging than in the military environment, albeit the caregivers are typically not putting their lives at risk to provide such care. Two organizations have pioneered remote damage control resuscitation in the civilian environment: Mayo Clinic and Royal Caribbean Cruises Ltd. The limitations in rural Minnesota and shipboard are daunting. Patients who have hemorrhage requiring transfusion are often hundreds of miles from hospitals able to provide damage control resuscitation. This article details the development and implementation of novel programs specifically designed to address the varied needs of patients in such circumstances. The Mayo Clinic program essentially takes a standard-of-care treatment algorithm, by which the patient would be treated in the emergency department or trauma bay, and projects that forward into the rural environment with specially trained prehospital personnel and special resources. Royal Caribbean Cruises Ltd has adapted a traditional military field practice of transfusing warm fresh whole blood, adding significant safety measures not yet reported on the battlefield (see within this Supplement the article entitled "Emergency Whole Blood Use in the Field: A Simplified Protocol for Collection and Transfusion"). The details of development, implementation, and preliminary results of these two civilian programs are described herein.
authors.affiliation: *Division of Trauma, Critical Care and Emergency General Surgery, Department of Surgery, Mayo Clinic; and †Mayo Clinic Transfusion Medicine, Rochester, Minnesota; ‡Medical Operations Royal Caribbean Cruises Ltd, Miami, Florida; §Mayo Clinic Medical Transport, Rochester, Minnesota; and ∥Norwegian Naval Special Operation Commando and ¶Department of Immunology and Transfusion Medicine, Haukeland University Hospital, and Institute of Clinical Science, University of Bergen, Bergen, Norway.
authors.forename: Donald
authors.initials: D
authors.lastname: Jenkins
authors.forename: James
authors.initials: J
authors.lastname: Stubbs
authors.forename: Steve
authors.initials: S
authors.lastname: Williams
authors.forename: Kathleen
authors.initials: K
authors.lastname: Berns
authors.forename: Martin
authors.initials: M
authors.lastname: Zielinski
authors.forename: Geir
authors.initials: G
authors.lastname: Strandenes
authors.forename: Scott
authors.initials: S
authors.lastname: Zietlow
mesh_terms: D000017:ABO Blood-Group System; D000465:Algorithms; D001782:Blood Donors; D001793:Blood Preservation / Q000379:methods; D001803:Blood Transfusion / Q000379:methods*; D004635:Emergency Medicine / Q000379:methods; D005260:Female; D006470:Hemorrhage / Q000628:therapy*; D006801:Humans; D008297:Male; D010949:Plasma / Q000737:chemistry*; D012151:Resuscitation / Q000379:methods*; D019035:Rural Health Services / Q000458:organization & administration; D012424:Rural Population; D012767:Ships
chemical_list: D000017:ABO Blood-Group System