Tactical Damage Control Resuscitation

Abstract

Recently the Committee on Tactical Combat Casualty Care changed the guidelines on fluid use in hemorrhagic shock. The current strategy for treating hemorrhagic shock is based on early use of components: Packed Red Blood Cells (PRBCs), Fresh Frozen Plasma (FFP) and platelets in a 1:1:1 ratio. We suggest that lack of components to mimic whole blood functionality favors the use of Fresh Whole Blood in managing hemorrhagic shock on the battlefield. We present a safe and practical approach for its use at the point of injury in the combat environment called Tactical Damage Control Resuscitation. We describe pre-deployment preparation, assessment of hemorrhagic shock, and collection and transfusion of fresh whole blood at the point of injury. By approaching shock with goal-directed therapy, it is possible to extend the period of survivability in combat casualties.

Group O low titre only emergency donor panels for small combat teams

“…The use of a group O only whole blood panel minimises this risk and is an attractive option if the collection of blood and/or administration is to be considered as part of an advanced field aider skill set 1. However, the plasma in whole blood is not inert and may be associated with adverse reactions including haemolysis.…”

“…This approach has been adopted by the US 75th Ranger Regiment (Special Forces) as part of their ‘Rangers O LOw titre’ or the ROLO initiative 1. The problem of such an approach is that the number of suitable group O donors may be insufficient when working in small teams.…”

Tactical damage control resuscitation in austere military environments

“…This is achieved through the application in the field of haemostatic resuscitation procedures called ‘remote DCR’17 or ‘tactical DCR’ 18…”

“…This concept has the advantage of always having available fresh whole blood, maintained indefinitely at 37°C and without storage constraints or much extra equipment. It is currently being considered by United States Special Operations Command (USSOCOM), Norwegian, Canadian and British troops 18 89–91…”

Bleeding management in remote environment: the use of fresh whole blood transfusion and lyophilised plasma

“…Therefore when life threatening bleeding occurs, blood products are critical. For resuscitation cases requiring massive transfusion, FWB is also more potent than the combination of packed red blood cells (RBC), platelets and fresh frozen plasma (FFP), with a better outcome for the patient [2][3][4]. This excellent potency is most probably due to the perfect 1/1/1 ratio for plasma, red cells and platelets, the low dose of conservative additives and anticoagulants compare to units of blood bank products, and not using large amounts of RBC older than 14 days since storage time affects quality of cells [5].…”