Goal

Optimize fluid resuscitation to treat and reverse hemorrhagic shock effectively. Fluid resuscitation principles in PFC are the same as TCCC. Blood products are strongly preferred, and every effort should be made to ensure the capability to transfuse blood products is available near the point of injury. Survival is improved when blood products are transfused within about 30 minutes of injury.25

Resuscitation products of choice for casualties in hemorrhagic shock, listed from most to least preferred, are:

- Whole blood
- Plasma, red blood cells (RBCs), and platelets in a 1:1:1 ratio
- Plasma and RBCs in a 1:1 ratio
- Plasma or RBCs alone
- Crystalloid (lactated Ringer’s or Plasma-Lyte A).

Caution: Crystalloids or Hextend are therapies of last resort and can worsen coagulopathy and bleeding. They should be used only in severely bleeding patients with no radial pulse when no blood products are available. Every effort should be made through training and preparation to ensure availability of stored blood products and ability to draw FWB.