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Crystalloids and colloids are used in prehospital fluid resuscitation to replace blood loss and preserve tissue perfusion until definite surgical control of bleeding can be achieved. However, large volumes of fluids will increase bleeding by elevating blood pressure, dislodging blood clots, and diluting coagulation factors and platelets. Hypotensive fluid resuscitation strategies are used to avoid worsening of uncontrolled bleeding. This is largely supported by animal studies. Most clinical evidence suggests that restricting fluid therapy is associated with improved outcome. Remote damage control resuscitation emphasizes the early use of blood products and restriction of other fluids to support coagulation and tissue oxygenation. Controversy regarding the optimal choice and composition of resuscitation fluids is ongoing. Compared with crystalloids, less colloid is needed for the same expansion of intravascular volume. On the other hand, colloids may cause coagulopathy not only related to dilution. The most important advantage of using colloids is logistical because less volume and weight are needed. In conclusion, prehospital fluid resuscitation is considered the standard of care, but there is little clinical evidence supporting the use of either crystalloids or colloids in remote damage control resuscitation. Alternative resuscitation fluids are needed.

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Introduction Hamid Karzai International Airport is a NATO military base connected to the international airport in Kabul, Afghanistan. It is one of the larger NATO installations in Afghanistan, and with its location being one of the main hubs for international transit, the base has been at the frontline since the beginning of the COVID-19 pandemic. Hamid Karzai International Airport base commanders and medical staff have been at the forefront, continually developing policies and procedures to mitigate the pandemic in a deployed setting. Material and Methods On base, approximately 4,000 people from 58 different nations lived within 0.5 km2. Diagnosis of COVID-19 was made by the detection of nucleic acid from the SARS-CoV-2 virus in nasopharyngeal/oropharyngeal swabs using real-time polymerase chain reaction (BioFire or GeneXpert). Serological tests (detecting IgM and IgG antibodies) were used as a screening tool. Data were reported from April 1 to September 12, 2020. Results Three thousand four hundred and sixty-six PCR tests were run in the reported period. Four hundred and seventy-eight positive cases were identified. Of these, only 106 reported symptoms. Seventy-eight presented spontaneously to the emergency room, while the remaining positive cases were identified as a result of aggressive testing of close contacts, base screening and surge testing. Twenty-two patients required oxygen treatment. One patient required mechanical ventilation and later died after strategic evacuation. Discussion Mitigation of COVID-19 was achieved by measures to reduce the spread of the virus, measures to reduce the population, and a medical response plan. To manage the logistic burden of isolating and quarantining a large portion of the population, a multinational and multidisciplinary COVID Task Force was formed. Conclusions In a military population of mostly young and healthy individuals, the majority of COVID-positive patients will have fewer symptoms, and therefore, the aggressive screening of asymptomatic personnel is necessary. Outbreaks of COVID-19 in a military base could have a detrimental impact on missions but may be contained and controlled with quarantine, isolation, and aggressive contact tracing.