ABSTRACT
Haemorrhage is the commonest cause of potentially preventable death after combat trauma, and significant bleeding into either the chest or abdominal cavities (or both) will almost always require a surgeon to correct it. The UK Defence Medical Services have adopted a damage control resuscitation (DCR) paradigm, in order to deliver an end-to-end trauma system incorporating rapid evacuation, early haemostatic resuscitation and damage control surgery (DCS) in order to improve battlefield mortality. DCS and negative laparotomies carry increased morbidity. The shock index (SI) has been demonstrated to be a useful parameter in aiding military surgeons in triaging ballistic battlefield torso trauma, thereby assisting in the identification of patients who potentially require operative torso haemorrhage control. One of the major drivers in DCS is arresting haemorrhage. Data from the conflict in Afghanistan demonstrated that two-thirds of dismounted fatalities had haemorrhage that may have been anatomically amenable to pre-hospital intervention implicated as a cause of death.
