Haemorrhage control of the pre-hospital trauma patient

Abstract

Haemorrhage following major injury remains the most common potentially preventable cause of traumatic death with exsanguination typically occurring within three hours of injury. Key to improving outcomes is a “care bundle” of measures to facilitate early diagnosis, rapid haemorrhage control, systemic and topical haemostatic support and short scene times [1]. The last decade has seen a paradigm shift in treatment strategies and transfu- sion algorithms [2] with an emphasis on haemostatic or damage control resuscitation (DCR). A key objective of this proactive and empiric approach to transfusion is to directly target Acute Traumatic Coagulopathy (ATC) which itself is associated with a four-fold increase in mortality and poor patient outcomes. This article will focus only on advanced interventions without further dis- cussion of the fundamentals of pre-hospital haemorrhage control i.e. oxygenation, intravenous or intra-osseous assess, pelvic and limb splints and splinting of the facial skeleton.