“Stop the Bleed”: A U.S. Military Installation’s Model for Implementation of a Rapid Hemorrhage Control Program

Abstract

Damage control resuscitation, advances in transfusion medicine, as well as the importance of tourniquet use demonstrated during Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) have helped to revolutionize modern trauma care. These lessons have dramatically improved casualty survival rates to the highest in our military’s history, and are now incorporated into civilian trauma centers in the USA and across the world.1,2 The risk of life-threatening hemorrhage from traumatic injury is the leading cause of death of Americans between the ages of 1 and 46, and is one of the most broadly reaching opportunities for military-civilian knowledge transfer. Outside military conflict, severe bleeding accounts for greater than 35% of pre-hospital deaths and nearly 40% of deaths within the first 24 hours of injury.3 Recent intentional attacks (Hartford, Las Vegas, Parkland, and others) have highlighted the threat posed by severe bleeding. Such attacks have occurred in high traffic locations such as schools, theaters, malls, universities, churches, and concert venues. Military bases have suffered these attacks as well, as demonstrated in Table 1, with 35 killed, and 57 wounded since 2000. The importance of early hemorrhage control, along with rapid identification of immediately correctible causes of death, has proven to save lives, and has evolved into a cornerstone of Tactical Combat Casualty Care (TCCC).4 This knowledge has already been adapted by the civilian groups such as the Committee for Tactical Emergency Casualty Care (C-TECC),5 and is becoming standard practice for civilian law enforcement, as well as tactical and emergency medical services teams worldwide.6