Catastrophic haemorrhage control: A brief report

In the civilian setting, haemorrhage contributes to death during the prehospital period in 33-56% of cases, and accounts for almost 50% of deaths in the first 24 hours of trauma care. Haemorrhage accounts for the largest proportion of mortality occurring within the first hour of trauma centre care [1]. In the military setting, Eastridge et al. [2] investigated 4596 deaths in war theatres over a 10-year period. They found that nearly 25% were “potentially survivable”, and that 91% of these potentially survivable deaths were due to uncontrolled blood loss. They estimate that adequate haemorrhage control could have saved over 1000 of these fatalities. Current opinion is that uncontrolled coagulopathic haemorrhage is now the major cause of potentially preventable death following trauma [3]. Stopping haemorrhage early will result in better outcomes for patients. But how can we achieve this? Whilst lessons can be learned from military studies and the results applied to civilian systems, we must not forget that the populations studied and interventions available vary dramatically between these two settings [4]. Military populations generally comprise of physically fit, young and healthy subjects (mainly male), whilst civilian populations are a mix of male and female, young and old, trauma and medical presentations, with many patents have underlying co-morbidities such as diabetes, heart disease, hypertension etc. These differences in populations studied mean the results from military studies may not be reflected when the interventions are applied to civilian populations. The American College of Surgeons Committee on Trauma released a document entitled “An evidence-based prehospital guideline for external haemorrhage control” in 2014 [4]. In this document, they review the evidence base for current haemorrhage control interventions. This article will review the components of this protocol, and some additional haemorrhage control devices and strategies. Measures to control catastrophic haemorrhage include provision of basic first aid training to all, specifically haemorrhage control training to police and other first responders, early use of tourniquets and haemostatic agents, application of splinting and the early administration of tranexamic acid and blood products.