Many efforts in the pre-hospital combat environment had been aimed at  prolonging the viability of a patient until they are able to make it to a  surgeon. The goal of military triage and evacuation is to have urgent  surgical patients to a waiting surgical team within 2 hours. Despite our  best efforts, this is not always possible. When it is not possible,it  is important to do the simple interventions which we know make a  difference for combat casualties such as tourniquets, wound packing,  needle decompression, airway adjuncts and pelvic binding. Wounds causing  non-compressible hemorrhage to the torso need additional strategies to  bridge the time and space gap to definitive treatment. A non-surgical  adjunct which has shown much promise has been the early transfusion of  whole blood and blood products until surgical care can be provided. Our  newest Clinical Practice Guideline on Remote Damage Control  Resuscitation details what should be done and why.  There is an entirely separate working group, The Tactical Hemostasis,  Oxygenation and Resuscitation (THOR) group dedicated to exactly those  principles which we partnered with early on to help identify solutions  dealing with hemorrhagic shock. Despite all that effort and brain power  however, blood remains a finite resource in the austere environment and  Medics have faced terrible situations where even blood administration is  not enough and surgery is too far away. It is in these times of  worst-case desperation that we want to do more for our patients. Some of  the adjuncts discussed in this episode are abdominal tourniquets, REBOA  and open surgical procedures. We don’t take any of this lightly and  realize that for the vast majority of our pre-hospital audience, many of  the procedures discussed are far outside the current scope of practice.  

What is possible?  

What is responsible?  

What is sustainable?   

Enjoy the talk.