How Hemorrhage Control Became Common Sense

Background Just over 200 years ago, surgeons were puzzled that the use of the tourniquet to control hemorrhage as common sense during surgery was a relatively recent development. Within the last 20 years, much progress has been made to controlling hemorrhage in the prehospital context. Then, as now, it was surprising that progress on something that appeared obvious had occurred only recently, begging the question how controlling blood loss was common sense in a surgical context, but not for emergency treatment. Methods Paper is a historical survey of the evolution of the medical understanding of hemorrhage along with technological response. Results The danger of blood loss had historically been consistently underestimated as physicians looked at other explanations for symptoms of how the human body responded to trauma. As the danger from hemorrhage became apparent, even obvious, responsibility for hemorrhage control was delegated down from the surgeon to the paramedic and eventually to individual service members and civilian bystanders with training to “Stop the Bleed.” Discussion Hippocratic medicine assumed that blood diffused centrifugally into periphery through arteries. William Harvey’s observation in 1615 that blood ran through a closed circulatory system gradually transformed conventional wisdom about blood loss, leading to the development of the tourniquet about a century later by Jean-Louis Petit, which made amputation of limbs survivable. However, physicians were cautious about their application during the First World War over concerns over effects on patient recovery. Hemorrhage had generally been seen as symptom to be managed until the patient would be seen by a surgeon who would stop the bleeding. More thorough collection and analysis of data related to case histories of soldiers wounded during the Vietnam Conflict transformed how surgeons understood the importance to hemorrhage leading to development of the doctrine of Tactical Combat Casualty Care in the late 1990’s. Study Type economic/decision Level of Evidence Background Information Corresponding Address: Alan Hawk, Historical Collections, National Museum of Health and Medicine, J-9, Defense Health Agency, 2460 Linden La., Silver Spring, MD 20910. Phone: (301) 319-3361. Fax: (301) 319-3373. Contact: Alan.j.hawk.civ@mail.mil, 301-319-3361 No Conflicts to report. The opinions and assertions contained herein are those of the author and do not necessarily represent the views of the National Museum of Health and Medicine or the Department of Defense (DoD), any of the military services or other DoD components or any other government agencies, and does not constitute an endorsement by the DoD of any of the opinions expressed, or any information, products or services contained therein. Presented at: 2017 Military Health System Research Symposium, August 28 2017, Kissimmee, Florida © 2018 Lippincott Williams & Wilkins, Inc.

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