Pre-hospital environment bleeding: from history to future prospects

Area of Science:

• Trauma Care
• Emergency Medicine
• Surgical Resuscitation

Background:

• Hemorrhagic shock in trauma patients is a primary cause of mortality and organ dysfunction.
• Current pre-hospital resuscitation often relies on crystalloid solutions, but fluid choices are under review.
• Historical understanding of blood and circulation predates scientific investigation of the circulatory system.

Purpose of the Study:

• To review the history of pre-hospital bleeding management.
• To explore current and future strategies for bleeding control in pre-hospital settings.
• To discuss advancements in damage control resuscitation and coagulopathy management.

Main Methods:

• Review of historical practices in bleeding management.
• Discussion of contemporary pre-hospital interventions (e.g., tourniquets, REBOA, hemostatic agents).
• Analysis of damage control resuscitation protocols, including tranexamic acid and massive transfusion feasibility.
• Examination of decision-making processes and proposed treatment flowcharts.

Main Results:

• Pre-hospital bleeding control has evolved significantly beyond simple compression.
• New interventions like tourniquets, topical hemostatics, and REBOA offer advanced bleeding control options.
• Understanding coagulopathy and implementing strategies like tranexamic acid are crucial for improving outcomes.

Conclusions:

• Effective pre-hospital bleeding management requires a deep understanding of coagulopathy.
• Advanced interventions and protocols are essential for reducing mortality in trauma patients with hemorrhagic shock.
• Future pre-hospital care necessitates integrating new knowledge and tools for superior bleeding control.