Hemostatic dressings also first came to prominence in battlefield settings, but have since become widely adopted in the civilian sector. Hemostatic dressings made of primarily of minerals or polysaccharides (such as QuikClot or HemCon) act as either factor concentrators, procoagulants, or muco-adhesives, and help stem hemorrhage in the field by (used by EMS), in austere environments, or in the emergency department until definitive management can be obtained.^7,10,11 These types of materials have also been used successfully incorporated for hemorrhagic control of common emergency medicine complaints such as epistaxis, post-surgical bleeding, and lacerations.⁷ Additionally, after its success in the military at decreasing mortality in patients with combat injuries, TXA has been similarly adapted to civilian use for everything from trauma to epistaxis to post-partum hemorrhage, with various degrees of success that

are still not fully studied.^12-14

In severe trauma, hemorrhage control is only the first step; access must be obtained and resuscitation initiated. Given the difficulty of securing intravenous (IV) access in the field, battlefield medicine has been relying on intraosseous access for decades, a method often preferred to venous cutdown.^7,10,15 This method, useful for drawing some labs and more importantly for giving fluids, blood products, and medication, has translated successfully to the care of civilian trauma and even medical patients when timely resuscitation is needed.^7,10,15

Knowledge from military medicine revolutionized civilian trauma resuscitation—the previous paradigm of crystalloids or colloids was abandoned for a 1:3 ratio of plasma to pRBC, the newest evidence points to a 1:1:1 ratio of platelets to plasma to pRBC.^1,7,10,16,17 “At the Amtrak MCI, our helicopter crews carried blood products and were able to transfuse on scene,” Dr. Stilley says, “which makes a difference when the nearest trauma center is almost an hour away.” Presently, military medicine is examining fresh whole blood transfusions, which have the benefit of being readily available from other soldiers (i.e., “walking blood banks”) and which have few additives and dilutional components, making whole blood transfusion ideal for patients with immediate threats to life or limb in austere settings or with metabolic derangements or coagulopathy.¹⁶ However, fresh whole blood likely has limited use in the civilian setting due to blood donor logistics and risk of blood-borne infections.¹⁶ “Whole blood is in many ways the ideal resuscitation fluid,” Dr. Fontenette notes, and he hopes that low titer group O whole blood, which is unseparated blood with low IgM and IgG anti-A and anti-B antibodies, may prove more translatable to civilian medicine.^18,19