Forward Hemorrhage Control During Prolonged Evacuation

Area of Science:

• Trauma and Emergency Medicine
• Hemorrhagic Shock Management
• Prehospital Care Strategies

Background:

• Uncontrolled hemorrhage is a primary cause of preventable death after traumatic injury.
• Fatalities from hemorrhagic shock occur within hours of injury, emphasizing the need for early intervention.
• Current global conflicts and disaster preparedness highlight the necessity for effective prehospital resuscitation strategies.

Purpose of the Study:

• To outline evidence-based, practical strategies for prehospital hemostatic resuscitation.
• To address the feasibility of early resuscitation in austere environments.
• To propose scalable clinical governance for prehospital care in conflict zones.

Main Methods:

• Integration of panel discussions and supporting documents.
• Synthesis of expert insights on "good, bad, and hard realities" of prehospital resuscitation.
• Focus on protocol-based, auditable pathways for early interventions.

Main Results:

• Early administration of low-titer O whole blood is ideal when logistics permit.
• Plasma-based bridging strategies (spray- or freeze-dried plasma) are crucial when blood is constrained.
• Mandatory early adjuncts include tranexamic acid and calcium.

Conclusions:

• Forward resuscitation strategies must be feasible for prehospital teams in austere settings.
• Simple, auditable pathways incorporating early blood products, plasma, tranexamic acid, and calcium can reduce preventable mortality.
• Practical next steps for clinical governance are proposed for prehospital care in Ukraine under conflict constraints.