INITIAL RESUSCITATION

These casualties typically arrive in extremis shortly after injury. Due to the severity of injury and exsanguinating hemorrhage, DCBI casualties with long field/transport times, particularly with no access to prehospital whole blood will likely die prior to arrival to the Role 2 or Role 3 medical treatment facility (MTF). Tourniquets (TQs) should be in place on all injured extremities. If the TQs are not in place, the extremities will rarely be significantly bleeding secondary to profound hemorrhagic shock. These casualties might arrive with a sternal or humeral head Intraosseous (IO) in place. Blood must be transfused through these access portals immediately, if it is not already being transfused. One challenge to the MTF provider is that IOs frequently get dislodged during transport. Do not rely solely on the IO. A large bore resuscitation line should be placed in the neck or an uninjured upper extremity. The best resuscitation line to place is the one that can be placed the fastest. Every minute matters in these casualties and the faster blood can be transfused though a central line or large bore IV (or rapid infusion catheter) the better the chance of survival.