TY - JOUR
T1 - External Hemorrhage Control Techniques for Human Space Exploration
T2 - Lessons from the Battlefield
AU - Thoolen, Stijn J. J.
AU - Kuypers, Maybritt
N1 - Funding Information: This work is the result of a library project by ST as part of the Space Physiology and Health MSc at King's College, London, UK. We would further like to acknowledge Christopher Schubert, medical training lead at the NASA Johnson Space Center, for his insightful comments and input on the manuscript. Author Contributions: study concept and design (ST, MK); acquisition of data (ST); drafting of manuscript (ST); critical revision of the manuscript (MK); approval of final manuscript (ST, MK). Financial/Material Support: None. Disclosures: None. Publisher Copyright: © 2023 Wilderness Medical Society
PY - 2023/6
Y1 - 2023/6
N2 - The past few decades of military experience have brought major advances in the prehospital care of patients with trauma. A focus on early hemorrhage control with aggressive use of tourniquets and hemostatic gauze is now generally accepted. This narrative literature review aims to discuss external hemorrhage control and the applicability of military concepts in space exploration. In space, environmental hazards, spacesuit removal, and limited crew training could cause significant time delays in providing initial trauma care. Cardiovascular and hematological adaptations to the microgravity environment are likely to reduce the ability to compensate, and resources for advanced resuscitation are limited. Any unscheduled emergency evacuation requires a patient to don a spacesuit, involves exposure to high G-forces upon re-entry into Earth's atmosphere, and costs a significant amount of time until a definitive care facility is reached. As a result, early hemorrhage control in space is critical. Safe implementation of hemostatic dressings and tourniquets seems feasible, but adequate training will be essential, and tourniquets are preferably converted to other methods of hemostasis in case of a prolonged medical evacuation. Other emerging approaches such as early tranexamic acid administration and more advanced techniques have shown promising results as well. For future exploration missions to the Moon and Mars, when evacuation is not possible, we look into what training or assistance tools would be helpful in managing the bleed at the point of injury.
AB - The past few decades of military experience have brought major advances in the prehospital care of patients with trauma. A focus on early hemorrhage control with aggressive use of tourniquets and hemostatic gauze is now generally accepted. This narrative literature review aims to discuss external hemorrhage control and the applicability of military concepts in space exploration. In space, environmental hazards, spacesuit removal, and limited crew training could cause significant time delays in providing initial trauma care. Cardiovascular and hematological adaptations to the microgravity environment are likely to reduce the ability to compensate, and resources for advanced resuscitation are limited. Any unscheduled emergency evacuation requires a patient to don a spacesuit, involves exposure to high G-forces upon re-entry into Earth's atmosphere, and costs a significant amount of time until a definitive care facility is reached. As a result, early hemorrhage control in space is critical. Safe implementation of hemostatic dressings and tourniquets seems feasible, but adequate training will be essential, and tourniquets are preferably converted to other methods of hemostasis in case of a prolonged medical evacuation. Other emerging approaches such as early tranexamic acid administration and more advanced techniques have shown promising results as well. For future exploration missions to the Moon and Mars, when evacuation is not possible, we look into what training or assistance tools would be helpful in managing the bleed at the point of injury.
KW - advanced trauma life support
KW - bleeding
KW - resuscitation
KW - spaceflight
KW - tactical combat casualty care
UR - http://www.scopus.com/inward/record.url?scp=85150035417&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.wem.2023.01.006
DO - https://doi.org/10.1016/j.wem.2023.01.006
M3 - Review article
C2 - 36906432
SN - 1080-6032
VL - 34
SP - 231
EP - 242
JO - Wilderness & environmental medicine
JF - Wilderness & environmental medicine
IS - 2
ER -