Management of traumatic haemorrhage--the US perspective

As compared with European practice, the American approach to resuscitation from traumatic haemorrhage de-emphasises pre-hospital interventions in favour of rapid transport to definitive care; limits initial surgical interventions under the damage control model; uses crystalloid as the initial fluid of choice; and follows an empiric 1:1:1 approach to transfusion with red cells, plasma and platelets in hemodynamically unstable and actively bleeding patients. The use of bedside visco-elastic testing to guide coagulation support is not as widespread as in Europe, while the early administration of tranexamic acid is more selective.