Treatment of anaemia has changed substantially since the early 1990s. In trauma, a subset of patients will require a significant volume of blood. Recent military experience has shown the value of "damage control resuscitation". This implies that damage control techniques are used from the time of injury, by minimising the time between injury and care, and providing aggressive control of haemorrhage, prevention of hypothermia and acidosis, optimising haemodynamic management in intensive care

more »

... intensive care units, and rationalising transfusion support in severely injured patients. The military use of whole blood has minimised some of the risks of component therapy, and has also shown that survival is improved. From this philosophy has come the change in protocol in civilian practice towards early haemostasis, limiting the use of crystalloid or fluid resuscitation (hypotensive resuscitation), and the early use of blood and blood products to maintain the normal coagulation profile as much as possible. Civilian surgeons have modified their practice, and the result has been an improvement in the outcomes of these patients.