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Hemorrhage Control on the Battlefield

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The effect of prehospital transport time, injury severity, and blood transfusion on survival of US military casualties in Iraq.
Kotwal RS, Scott LLF, Janak JC, Tarpey BW, Howard JT, Mazuchowski EL, Butler FK, Shackelford SA, Gurney JM, Stockinger ZT
J Trauma Acute Care Surg. 2018 Jul;85(1S Suppl 2):S112-S121.

Rationale for inclusion: Data from OIF, prehospital blood transfusion and battlefield survival.

Citations  - To review the number of citations for this landmark paper, visit Google Scholar.

Association of Prehospital Blood Product Transfusion During Medical Evacuation of Combat Casualties in Afghanistan With Acute and 30-Day Survival.
Shackelford SA1, Del Junco DJ1,2, Powell-Dunford N3, Mazuchowski EL4, Howard JT1, Kotwal RS1, Gurney J1, Butler FK Jr1, Gross K5, Stockinger ZT1.
JAMA. 2017 Oct 24;318(16):1581-1591.

Rationale for inclusion: Data from OEF, prehospital blood transfusion and battlefield survival.

Citations  - To review the number of citations for this landmark paper, visit Google Scholar.

Survival with emergency tourniquet use to stop bleeding in major limb trauma.
Kragh JF Jr, Walters TJ, Baer DG, Fox CJ, Wade CE, Salinas J, Holcomb JB.
Ann Surg. 2009 Jan;249(1):1-7.

Rationale for inclusion:  This is a relatively large study on the use of tourniquets in a combat hospital. The results are striking in that tourniquet use when applied early (before evidence of shock) was associated with survival in 90% versus 10% when applied in those already in shock.

Citations  - To review the number of citations for this landmark paper, visit Google Scholar.

QuikClot use in trauma for hemorrhage control: case series of 103 documented uses.
Rhee P, Brown C, Martin M, Salim A, Plurad D, Green D, Chambers L, Demetriades D, Velmahos G, Alam H.
J Trauma. 2008 Apr;64(4):1093-9.

Rationale for inclusion: This is unique study in that both military and civilian, surgeons and pre-hospital providers used Quickclot for hemorrhage control in over 100 cases. It was found to effective, especially in the pre-hospital setting. Only 3 cases of burns were encountered.

Citations  - To review the number of citations for this landmark paper, visit Google Scholar.

Practical use of emergency tourniquets to stop bleeding in major limb trauma.
Kragh JF Jr, Walters TJ, Baer DG, Fox CJ, Wade CE, Salinas J, Holcomb JB.
J Trauma. 2008 Feb;64(2 Suppl):S38-49; discussion S49-50.

Rationale for inclusion: This study on tourniquet use on combat injured patients provides data that supports very minimal morbidity associated with tourniquet use including nerve palsy and no limb loss due to tourniquet use in this study. 

Citations  - To review the number of citations for this landmark paper, visit Google Scholar.

Prehospital tourniquet use in Operation Iraqi Freedom: effect on hemorrhage control and outcomes.
Beekley AC, Sebesta JA, Blackbourne LH, Herbert GS, Kauvar DS, Baer DG, Walters TJ, Mullenix PS, Holcomb JB; 31st Combat Support Hospital Research Group.
J Trauma. 2008 Feb;64(2 Suppl):S28-37; discussion S37.

Rationale for inclusion:  This is another study on tourniquet use at a combat hospital that further supports the use of tourniquets to aid in hemorrhage control in extremity injuries. No adverse outcomes were cited, and tourniquet use might have positively impacted potentially preventable deaths.

Citations  - To review the number of citations for this landmark paper, visit Google Scholar.

Tourniquets for hemorrhage control on the battlefield: a 4-year accumulated experience.
Lakstein D, Blumenfeld A, Sokolov T, Lin G, Bssorai R, Lynn M, Ben-Abraham R.
J Trauma. 2003 May;54(5 Suppl):S221-5.

Rationale for inclusion:  This study utilizes data that mostly pre-dates the US involvement in the Iraq and Afghanistan. The Israeli Defense Forces provide data supporting tourniquet use by pre-hospital medical and non-medical personnel as means of hemorrhage control in those with exsanguinating extremity wounds.

Citations  - To review the number of citations for this landmark paper, visit Google Scholar.

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