University of Lynchburg DMSc Doctoral Project Assignment Repository

University of Lynchburg DMSc Doctoral Project Assignment Repository


prehospital trauma


Dr. Bernard Toney



Objective: The purpose of this article is to review prehospital hemorrhage protocols and identify best practices.

Method: A PubMed search was conducted using search terms prehospital hemorrhage, shock, massive transfusion, and damage control resuscitation. Additional searches for relevant primary literature were performed. Evidence from the literature review was compared alongside the Joint Trauma System’s Damage Control Resuscitation Guidelines. All of the identified research pertains to studies involving adult patients; this review bears no implication on pediatric hemorrhage resuscitation protocols.

Results: Evidence for prehospital blood transfusion is considered low-quality, but the practice is considered safe and effective. Crystalloids are not preferred for prehospital hemorrhage resuscitation. Permissive hypotension seems safer than large volume crystalloid transfusion. Tranexamic acid (TXA) and plasma show promise as prehospital hemorrhage resuscitation adjuncts. Prehospital packed red blood cells (pRBC) transfused with plasma have demonstrated greatest survival benefit for prehospital hemorrhage treatment. Further research is needed on the role of whole blood in prehospital hemorrhage resuscitation.

Conclusion: Blood products should be used in prehospital hemorrhagic shock resuscitation. If blood products are not available, a controlled resuscitation strategy seems most appropriate. Appropriate pre-hospital management of massive hemorrhage is a subject of debate, but identifying a best and practical approach should improve outcomes for trauma patients.

Keywords: Prehospital, Hemorrhage, Shock, Resuscitation.


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