Extrapolation of battlefield resuscitative care to the civilian setting

Experiences in treating wartime casualties in Iraq and Afghanistan have already led to changes in civilian trauma care practices. While advances in the care of civilian musculoskeletal injuries are likely as a result of ongoing military basic and clinical research, major advances in resuscitative care have already been realized. Early liberal use of tourniquets to control bleeding from combat-associated extremity trauma has led to decreased mortality. Military experience has demonstrated that use of temporary intravascular shunts is effective for mitigating ischemic injury from vascular trauma until definitive repair can be accomplished. Hemostatic dressings have improved the surgeon's hemorrhage control armamentarium. Clinical experience with hypotensive resuscitation has led to refinement and improvement in the technique. Use of recombinant factor VIIa has improved hemorrhage control in the context of brain injury and coagulopathy and increasing the ratio of plasma to red cells during early shock resuscitation has improved survival.