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packed red blood cells to carry oxygen. e saline was included because it was thought that maintain- ing a normal blood pressure was beneficial. Today, however, the patient's blood pressure is kept just high enough to keep blood circulating to the brain but below normal blood pressure levels, which we now know helps reduce blood loss. Also, it turns out that saline can actually be harmful to the pa- tient, making it more difficult for blood to clot and potentially causing so much stress that the body begins to shut down. As a result, saline is no longer given during DCR. As for the blood transfusions, thanks to a study of records from a U.S. combat support hospital, it was discovered that for patients with combat-related trauma who required massive transfusions, a 1:1.4 ratio of plasma to red blood cells (RBC) infusions led to improved survival rates and that a 1:1 ratio of plasma to RBCs was best for patients who are hypo- coaguable (bleeding out) from traumatic injuries. Navy contacted the author of the study, Dr. Philip Spinella (who separated from the Army aer 12 years of active duty and a 1-year deploy- ment in Operation Iraqi Freedom), who confirmed that standard practice evolved from a crystalloid [saline-based] approach to an RBC-based approach and has since moved on to a 1:1:1 ratio of RBCs, plasma, and platelets. Lt. Col. Hatzfeld noted that this has since become standard practice in many parts of the world and there is now a strong emphasis on giving trauma patients whole blood (if available) because they need every- thing that is in blood, not just the red blood cells and platelets. Changes as simple as these may not sound ter- ribly exciting, but since 2008 they have been saving many lives that might otherwise have been lost. TRAUMA TRANSPORT Another significant change in the care of trauma patients is the establishment of the cross-ser- vice Joint Trauma System. Previously, each unit (battalion, air wing, etc.) was responsible for its own people. ey created and managed their own systems to provide initial care to the wounded and made subsequent arrangements for the wounded to be transported to rehabilitative facilities via heli- copter, truck, or airplane. is system required each unit to provide fairly sophisticated medical care and it could take days for transport to better medical facilities to be arranged, which was both inefficient and potentially harmful to the patient. In 2003, the Joint Trauma System (JTS) was MC MICHAEL B. WATKINS Seabees assigned to Naval Mobile Construction Battalion (NMCB) 40 conduct a mass casualty drill at Fort Hunter Liggett, Calif. NMCB- 40 is participating in its final field training exercise and evaluation before their 2011 deployment to the U.S. Pacific Command. 27 Association of the United States Navy

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