Related Experiment Video
Updated: Oct 5, 2025
Integrated Compensatory Responses in a Human Model of Hemorrhage
Published on: November 20, 2016
Advanced bleeding control in combat casualty care: An international, expert-based Delphi consensus
Suzanne M Vrancken1, Boudewijn L S Borger van der Burg, Joseph J DuBose
1From the Department of Surgery (S.M.V., B.L.S.B.v.d.B., R.H.), Alrijne Hospital, Leiderdorp, the Netherlands; Trauma Research Unit, Department of Surgery (S.M.V., R.H.), Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; R Adams Cowley Shock Trauma Center (J.J.D.), University of Maryland, Baltimore, Maryland; Naval Medical Research Unit San Antonio (J.J.G.), JBSA-Ft. Sam Houston, Texas; San Antonio Military Medical Center (J.J.G.), JBSA-Ft. Sam Houston, Texas; Department of Cardiothoracic and Vascular Surgery (T.M.H.), Faculty of Medicine and Health, Örebro University Hospital, Örebro University, Örebro, Sweden; Department of Surgery, Faculty of Medicine and Health (T.M.H.), Örebro University Hospital, Örebro University, Örebro, Sweden; Defense Healthcare Organization, Ministry of Defense (R.H.), Utrecht, the Netherlands; and Department of Surgery, Leiden University Medical Centre (R.H.), Leiden, the Netherlands.
Background:
Hemorrhage from truncal and junctional injuries is responsible for the vast majority of potentially survivable deaths in combat casualties, causing most of its fatalities in the prehospital arena. Optimizing the deployment of the advanced bleeding control modalities required for the management of these injuries is essential to improve the survival of severely injured casualties. This study aimed to establish consensus on the optimal use and implementation of advanced bleeding control modalities in combat casualty care.
Methods:
A Delphi method consisting of three rounds was used. An international expert panel of military physicians was selected by the researchers to complete the Delphi surveys. Consensus was reached if 70% or greater of respondents agreed and if 70% or greater responded.
Results:
Thirty-two experts from 10 different nations commenced the process and reached consensus on which bleeding control modalities should be part of the standard equipment, that these modalities should be available at all levels of care, that only trained physicians should be allowed to apply invasive bleeding control modalities, but all medical and nonmedical personnel should be allowed to apply noninvasive bleeding control modalities, and on the training requirements for providers. Consensus was also reached on the necessity of international registries and guidelines, and on certain indications and contraindications for resuscitative endovascular balloon occlusion of the aorta (REBOA) in military environments. No consensus was reached on the role of a wound clamp in military settings and the indications for REBOA in patients with chest trauma, penetrating axillary injury or penetrating neck injury in combination with thoracoabdominal injuries.
Conclusion:
Consensus was reached on the contents of a standard bleeding control toolbox, where it should be available, providers and training requirements, international registries and guidelines, and potential indications for REBOA in military environments.
Related Concept Videos
01:29Venous Thrombosis III: Interprofessional Care
01:05Introduction to Hemostasis
The three phases of hemostasis involve many clotting factors present in plasma and several substances released by platelets and injured tissue cells. It is a fast, localized,...