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.
Keywords
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Published online: March 09, 2023
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