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Catastrophic haemorrhage in military major trauma patients: a retrospective database analysis of haemostatic agents used on the battlefield
  1. Mark Winstanley1,
  2. J E Smith2,3 and
  3. C Wright3,4
  1. 1 Emergency Department, John Radcliffe Hospital, Oxford, UK
  2. 2 Emergency Department, Derriford Hospital, Plymouth, UK
  3. 3 Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine, Birmingham, UK
  4. 4 Emergency Department, Imperial College Hospital, London, UK
  1. Correspondence to Dr C Wright, ; chris.wright17{at}


Objectives Catastrophic haemorrhage is a leading cause of morbidity and mortality in trauma, in both military and civilian settings. There are numerous studies looking at the effectiveness of different haemostatic agents in the laboratory but few in a clinical setting. This study analyses the use of haemostatic dressings used in patients injured on the battlefield and their association with survival.

Method A retrospective database review was undertaken using the UK Joint Theatre Trauma Registry from 2003 to 2014, during combat operations in Iraq and Afghanistan. Data included patient demographics, the use of haemostatic dressings, New Injury Severity Score (NISS) and patient outcome.

Results Of 3792 cases, a haemostatic dressing was applied in 317 (either Celox, Hemcon or Quickclot). When comparing patients who had a haemostatic dressing applied versus no haemostatic agent, there was a 7% improvement in survival. Celox was the only individual haemostatic dressing that was associated with a statistically significant improvement in survival, which was most apparent in the more severely injured (NISS 36–75).

Conclusion We have shown an association between use of haemostatic agents and improved survival, mostly in those with more severe injuries, which is particularly evident in those administered Celox. This supports the continued use of haemostatic agents as part of initial haemorrhage control for patients injured in conflict and suggests that civilian organisations that may need to deal with patients with similar injury patterns should consider their use and implementation.

  • trauma management
  • accident & emergency medicine
  • wound management

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  • Contributors All authors have made the appropriate level of contribution to be listed as authors in the order stated.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; internally peer reviewed.