title: Tactical damage control resuscitation in austere military environments.
abstract: BACKGROUND
  Despite the early uses of tourniquets and haemostatic dressings, blood loss still accounts for the vast majority of preventable deaths on the battlefield. Over the last few years, progress has been made in the management of such injuries, especially with the use of damage control resuscitation concepts. The early application of these procedures, on the field, may constitute the best opportunity to improve survival from combat injury during remote operations.
  
  
  METHODS
  Currently available literature relating to trauma-induced coagulopathy treatment and far-forward transfusion was identified by searches of electronic databases. The level of evidence and methodology of the research were reviewed for each article. The appropriateness for field utilisation of each medication was then discussed to take into account the characteristics of remote military operations.
  
  
  CONCLUSIONS
  In tactical situations, in association with haemostatic procedures (tourniquet, suture, etc), tranexamic acid should be the first medication used according to the current guidelines. The use of fibrinogen concentrate should also be considered for patients in haemorrhagic shock, especially if point-of-care (POC) testing of haemostasis or shock severity is available. If POC evaluation is not available, it seems reasonable to still administer this treatment after clinical assessment, particularly if the evacuation is delayed. In this situation, lyophilised plasma may also be given as a resuscitation fluid while respecting permissive hypotension. Whole blood transfusion in the field deserves special attention. In addition to the aforementioned treatments, if the field care is prolonged, whole blood transfusion must be considered if it does not delay the evacuation.
authors.affiliation: Antenne médicale spécialisée, Base des Fusiliers Marins et des Commandos, Lanester, France.
authors.forename: Yann
authors.initials: Y
authors.lastname: Daniel
authors.affiliation: Antenne médicale spécialisée, Base des Fusiliers Marins et des Commandos, Lanester, France.
authors.forename: S
authors.initials: S
authors.lastname: Habas
authors.affiliation: Antenne médicale spécialisée, Base des Fusiliers Marins et des Commandos, Lanester, France.
authors.forename: L
authors.initials: L
authors.lastname: Malan
authors.affiliation: Hôpital d'Instruction des Armées Desgenettes, Lyon, France.|Direction Régionale du Service de Santé des Armées, Lyon, France.
authors.forename: J
authors.initials: J
authors.lastname: Escarment
authors.affiliation: Service d'Anesthésie Réanimation, Hôpital Edouard Herriot, Lyon, France.|Université Claude Bernard, Lyon, France.
authors.forename: J-S
authors.initials: JS
authors.lastname: David
authors.affiliation: Antenne médicale spécialisée, Base des Fusiliers Marins et des Commandos, Lanester, France.
authors.forename: S
authors.initials: S
authors.lastname: Peyrefitte
mesh_terms: D000933:Antifibrinolytic Agents / Q000627:therapeutic use*; D001778:Blood Coagulation Disorders / Q000209:etiology / Q000628:therapy*; D001779:Blood Coagulation Factors / Q000627:therapeutic use; D016913:Blood Component Transfusion / Q000379:methods; D001803:Blood Transfusion / Q000379:methods*; D003029:Coagulants / Q000627:therapeutic use*; D005340:Fibrinogen / Q000627:therapeutic use; D005612:Freeze Drying; D006470:Hemorrhage / Q000628:therapy; D006801:Humans; D008887:Military Medicine; D008889:Military Personnel; D010949:Plasma; D000067716:Point-of-Care Testing; D012151:Resuscitation; D012771:Shock, Hemorrhagic / Q000175:diagnosis / Q000628:therapy*; D014148:Tranexamic Acid / Q000627:therapeutic use; D014947:Wounds and Injuries / Q000150:complications / Q000628:therapy*
chemical_list: D000933:Antifibrinolytic Agents; D001779:Blood Coagulation Factors; D003029:Coagulants; C025667:prothrombin complex concentrates; D014148:Tranexamic Acid; D005340:Fibrinogen
keywords: Blood transfusion; Fibrinogen; Hemorrhage; Plasma; War-Related Injuries