Reducing prehospital deaths through injury prevention remains an area with high opportunity for saving lives. Nevertheless, for trauma patients kinase inhibitor Erlotinib who experience massive blood loss, hemorrhage is a common cause of death [61].Civilian trauma and military trauma are not the sameTreatment of battle casualties represents an important area for the exploration of new treatments of trauma patients. Some aspects of trauma seen among soldiers and noncombatants wounded in theaters of war have similarities to trauma seen in civilian settings (for example, burns, gunshot wounds). However, substantial differences exist between civilian trauma and military trauma [62]. These differences include the characteristics of the underlying population, the nature of the trauma, and the treatments available.

For example, 93% of trauma in Canada is blunt trauma, with only 5% penetrating trauma and 2% burns [53]. In military trauma these proportions are reversed. The panel felt that observations, clinical reports, policies, and practice patterns obtained in and relevant to the theater of war, while of potential benefit to civilian healthcare [63], should not be considered immediately transferrable to civilian trauma patients.Practice recommendations for transfusion support of critical bleeding in trauma patientsTrauma care is complex, and outcomes depend on timing, the nature of the injury, patient age and co-morbidities, geographic location and transport times, surgical and anesthesia expertise, intensive care services, physiologic and laboratory assessment, and transfusion support.

Practitioners can find valuable information from several sources, listed in Table Table44 and in recently published guidelines [64-66]. The initial approach to the care of the injured patient should be in keeping with current principles – such as those detailed in the Advanced Trauma Life Support guidelines, which are regularly updated [67,68]. Direct control of bleeding with definitive management by surgery or interventional radiology remains the mainstay of therapy. The most important step in the transfusion support of trauma patients is the development of a local, agreed-upon practice approach to blood support.Table 4Resources on traumaRed blood cells and Dacomitinib tissue oxygenationTissue oxygenation remains the first goal of blood therapy. Because of the direct link between tissue ischemia, disordered hemostasis [31,69], and mortality, the most important blood component for prevention and treatment of coagulopathy is packed RBCs. Local policies should clearly provide for the rapid delivery of uncrossmatched RBCs. Life-saving RBC transfusion should not be delayed. Venous access of sufficient size for rapid blood infusion should be established without delay.