Even with advances in training and hemorrhage control methods (e.g., tourniquets and hemostatic dressings), the following three areas of focus for hemorrhage control are particularly challenging:
- Truncal hemorrhage,
- Junctional hemorrhage, and
- Peripheral extremity hemorrhage. [19]
Of all the combat deaths reported in the Eastridge study period, 90% happened prior to reaching definitive care. [19] Of those fatalities, 35% were instantaneous and 52% occurred within minutes to hours after the initial injury, and 75% of all of those casualties had non- survivable injuries. [19]
To draw parallels with the civilian population of trauma patients, the mechanisms of injury do not change, soldiers die from blunt and penetrating just as easily as civilians. The severity of the wounds caused by blasts and high speed projectiles are what sets combat casualties apart in this case. Death from penetrating trauma in combat casualties was attributed to gunshot wounds that took transthoracic routes through the body (characterized by entrance in the axillary area) as well as transcranial routes. [17] The mortality from the blunt trauma mechanism in combat casualties is characterized by blast injuries from improvised explosive devices (IEDs) that caused severe head trauma, massive extremity trauma, and at least 90% of these patients had massive thoracic trauma.[17] With the exception of the extremity trauma, these are all injuries that prehospital providers can do little for as far as treatment and resuscitation.
The resounding successes of combat trauma resuscitation and care of wounded soldiers have been due in part to new treatment devices and methods (e.g., tourniquets and hypotensive resuscitation. The partnership and endorsement of TC3 by the National Association of Emergency Medical Technicians and the American College of Surgeons validated these treatment modalities. [20] Civilian prehospital providers are becoming educated on new trauma resuscitation methods and systems designs that originated from the recent conflicts in Iraq and Afghanistan. Understanding the origin and context of this information helps to appropriately incorporate it into civilian daily clinical practices as they quickly become standard of care for trauma resuscitation.
