Bennett Brad L
Military & Emergency Medicine Department, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD.
Wilderness Environ Med. 2017 Jun;28(2S):S39-S49. doi: 10.1016/j.wem.2016.12.005. Epub 2017 Mar 17.
Based on lessons learned, many military battlefield trauma advances ultimately transition to enhance civilian trauma care. However, even with major strides to enhance battlefield hemorrhage control, it is unclear how effectively these techniques and products are being translated to civilian trauma. The purpose of this brief review is to present the evidence of current hemostatic product effectiveness, determine the evidence for transitioning of this technology to prehospital civilian application, and provide recommendations about potential use in the wilderness/austere setting. It is concluded that there is adequate evidence of hemorrhage control effectiveness in both military and civilian preclinical studies and clinical case series. The Committee on Tactical Combat Casualty Care recommends implementing approved hemostatic dressings as one part of a comprehensive hemorrhage control training and clinical management program. These recommendations for hemostatic dressings use by public safety and laypersons should be applied in acute transport urban settings or during prolonged care in austere environments.
基于经验教训,许多军事战场创伤方面的进展最终会转化为对平民创伤护理的改善。然而,即便在加强战场出血控制方面取得了重大进展,这些技术和产品在转化应用于平民创伤护理时的效果仍不明确。本简要综述的目的是展示当前止血产品有效性的证据,确定该技术转化应用于院前平民创伤护理的证据,并就其在野外/艰苦环境中的潜在用途提供建议。结论是,在军事和民用临床前研究以及临床病例系列中,均有足够的出血控制有效性证据。战术战斗伤救治委员会建议,将已获批的止血敷料作为全面出血控制培训和临床管理方案的一部分加以应用。公共安全人员和普通民众使用这些止血敷料的建议,应适用于城市急性转运环境或艰苦环境中的长期护理过程。