Literature review and knowledge gap analysis on "Combat Casualty Care in Cold Environments"

Luis da Luz, MD

Principal Investigator

Sunnybrook Hospital

Defence Research and Development Canada

Completion Date
March 2020

Optimal trauma care in a combat setting is well studied and largely based on the Tactical Combat Casualty Care guidelines (primarily hemorrhage control, airway, breathing and circulation management, and hypothermia prevention). While comprehensive, these guidelines lack consideration of additional challenges of providing care to injured patients in extreme cold environments. Moreover, a lack of evidence on a holistic view of care procedures in the overall prehospital setting was identified. The aim of this project was to review the current evidence on the management of injured patients in the prehospital, combat and extreme cold settings. The authors reported numerous effective aspects of combat care, such as the use of warming blankets, tourniquets and hemostatic dressings, transfusion of blood products and treatment of coagulopathies. Furthermore, they also identified important knowledge gaps on the influence of extreme low temperatures in administering different solutions to the patient, in the use of tourniquets, and in the endovascular balloons for bleeding control. More specifically, the authors recommended that more evidence is needed on what is the speed at which the different solutions freeze and how to avoid this process. Should tourniquets not be used because of the peripheral vasoconstriction? Will the endovascular balloons freeze and become non-collapsed? Finally, the authors suggest that further research on interventions and implementations of new techniques and devices are fundamental to develop the foundation of care for trauma patients in extreme cold settings.