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Curr Sports Med Rep. 2015 Mar-Apr;14(2):129-34. doi: 10.1249/JSR.0000000000000130.

The lost art of whole blood transfusion in austere environments.

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1Norwegian Naval Special Operations Commando, Bergen, Norway; 2Department of Immunology and Transfusion Medicine, Haukeland University Hospital, Bergen, Norway; 3Department of Anesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway; 4Medical Operations Royal Caribbean Cruises Ltd., Miami, FL; and 5U.S. Army Institute of Surgical Research, Joint Base San Antonio-Fort Sam Houston, TX.


The optimal resuscitation fluid for uncontrolled bleeding and hemorrhagic shock in both pre- and in-hospital settings has been an ongoing controversy for decades. Hemorrhage continues to be a major cause of death in both the civilian and military trauma population, and survival depends on adequacy of hemorrhage control and resuscitation between onset of bleeding and arrival at a medical treatment facility. The terms far-forward and austere are defined, respectively, as the environment where professional health care providers normally do not operate and a setting in which basic equipment and capabilities necessary for resuscitation are often not available. The relative austerity of a treatment setting may be a function of timing rather than just location, as life-saving interventions must be performed quickly before hemorrhagic shock becomes irreversible. Fresh whole blood transfusions in the field may be a feasible life-saving procedure when facing significant hemorrhage.

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