Summary of Changes

1. Inclusion of data from the DoD Trauma Registry (DoDTR) on incidence/prevalence and resuscitation requirements of this unique population.
2. Considerations for Zone 3 resuscitative endovascular balloon occlusion of the aorta (REBOA) for proximal control in casualties with high bilateral amputations.
3. Updated initial transfusion requirements and guidelines. Whole blood should be used preferentially, and crystalloid should not be used for resuscitation of these patients secondary to their profound shock state.
4. Clarified PI metrics to include the addition of:
   - Number/percentage of patients who undergo REBOA placement upon arrival to the medical treatment facility (MTF).
   - Documentation and tracking of transfusion requirements.
   - Use standardized OR sheet to be included in notes to Performance/Adherence Metrics (Appendix A: DCBI H&P supplement).
5. Rapid Update: 2 April 2026 PI Metrics updated