Pushing advanced hemorrhage control interventions forward: Reducing prehospital mortality from traumatic hemorrhage through further adoption of effective military prehospital strategies.

Abstract: Advancements in military medicine have had profound impacts on civilian trauma care. The current practices in civilian prehospital care focus on providing limited interventions in the field and rapid transport to higher levels of care. Very few prehospital emergency medical services in the United States have the capability to provide prehospital blood transfusions or advanced hemorrhage control procedures for trauma patients in hemorrhagic shock. As such, prehospital mortality from hemorrhage remains high. The United States military has adopted the use of prehospital blood transfusions during recent combat operations in the Middle East to mitigate prehospital mortality. Additionally, select military surgical teams capable of providing damage-control surgery as close to the point of injury as possible have been used to decrease the time to lifesaving interventions. This review seeks to assess current practices in civilian prehospital care within the United States while evaluating recent military medical lessons learned on prehospital blood products and minimizing time to lifesaving interventions, to identify potential opportunities to reduce mortality in civilian prehospital trauma care.

Level of evidence: Therapeutic/Care Management; Level V.