Advances in Tactical Combat Casualty Care: Contemporary Strategies for Hemorrhage Control, Neurotrauma Management, and Multidisciplinary Recovery in Modern Warfare
DOI:
https://doi.org/10.64784/228Palabras clave:
War trauma, Tactical medicine, Combat casualty care, Hemorrhage control, Traumatic brain injury, Neurotrauma, Military medicine, Damage control surgery, Damage control resuscitation, Combat hemorrhage, Military radiology, Neurocritical care, Blast injury, Battlefield medicine, Multidisciplinary trauma systems, Rehabilitation, Emergency medicine, Critical care, Trauma surgery, Combat injuriesResumen
Modern warfare has generated increasingly complex patterns of injury characterized by massive hemorrhage, traumatic brain injury, blast-related trauma, vascular damage, and multisystem injuries, creating significant challenges for military and civilian healthcare systems. Continuous advances in tactical medicine, combat casualty care, neurocritical care, radiological imaging, and damage control strategies have substantially improved the management of these injuries and reduced preventable mortality in combat environments. This review analyzes current innovations in war trauma management, emphasizing developments in hemorrhage control, traumatic brain injury management, advanced radiological technologies, damage control surgery, damage control resuscitation, and multidisciplinary trauma systems. A structured narrative review was conducted using the Scientific Method and PRISMA-based review principles. Scientific evidence was identified through PubMed/MEDLINE, Scopus, Web of Science, ScienceDirect, SpringerLink, Wiley Online Library, Cochrane Library, and Google Scholar, including peer-reviewed articles, clinical guidelines, systematic reviews, meta-analyses, and consensus statements published between 2005 and 2025. The available evidence demonstrates that Tactical Combat Casualty Care protocols, modern tourniquet systems, hemostatic dressings, balanced transfusion strategies, advanced neurocritical care, and innovative imaging techniques have significantly improved survival, neurological preservation, diagnostic accuracy, and long-term functional recovery among combat casualties. Furthermore, multidisciplinary trauma systems integrating tactical medicine, surgery, radiology, intensive care, and rehabilitation have strengthened continuity of care and enhanced patient outcomes throughout the recovery process. These advances have also influenced civilian trauma systems by improving emergency preparedness, disaster response, and management of severe traumatic injuries. Although important progress has been achieved, continued research remains necessary to optimize neuroprotective therapies, expand access to advanced technologies, improve rehabilitation strategies, and address the evolving challenges associated with modern warfare. Contemporary war trauma management has become a highly specialized, multidisciplinary, and evidence-based field whose innovations continue to shape the future of military and civilian trauma care worldwide.
Referencias
1. Benzinger, T. L. S., Brody, D., Cardin, S., Curley, K. C., Mintun, M. A., Mun, S. K., et al. (2009). Blast-related brain injury: Imaging for clinical and research applications. Radiology, 251(2), 363–376.
2. Boulton, A. J., Lewis, C. T., Naumann, D. N., Midwinter, M. J., & Smith, I. M. (2018). Prehospital haemostatic dressings for trauma: A systematic review. Emergency Medicine Journal, 35(7), 449–457.
3. Carney, N., Totten, A. M., O'Reilly, C., Ullman, J. S., Hawryluk, G. W. J., Bell, M. J., et al. (2017). Guidelines for the management of severe traumatic brain injury, fourth edition. Neurosurgery, 80(1), 6–15. https://doi.org/10.1227/NEU.0000000000001432
4. Deaton, T. G., Drew, B., Montgomery, H., & Butler, F. K. (2024). Tactical Combat Casualty Care (TCCC) Guidelines: 25 January 2024. Journal of Special Operations Medicine, 24(1), 100–108. https://doi.org/10.55460/QT3B-XK5B
5. Galbraith, C. M., Kazan, I., & Sise, M. J. (2023). Massive trauma and resuscitation strategies. Current Anesthesiology Reports, 13, 432–444.
6. Hawryluk, G. W. J., Rubiano, A. M., Totten, A. M., O'Reilly, C., Ullman, J. S., Bratton, S. L., et al. (2020). Guidelines for the management of severe traumatic brain injury: 2020 update of the decompressive craniectomy recommendations. Neurosurgery, 87(3), 427–434. https://doi.org/10.1093/neuros/nyaa278
7. Kragh, J. F., Jr., Walters, T. J., Baer, D. G., Fox, C. J., Wade, C. E., Salinas, J., & Holcomb, J. B. (2009). Survival with emergency tourniquet use to stop bleeding in major limb trauma. Annals of Surgery, 249(1), 1–7.
8. Kragh, J. F., Jr., Littrel, M. L., Jones, J. A., Walters, T. J., Baer, D. G., Wade, C. E., & Holcomb, J. B. (2011). Battle casualty survival with emergency tourniquet use to stop limb bleeding. The Journal of Emergency Medicine, 41(6), 590–597.
9. Lammers, D. T., Holcomb, J. B., & Cotton, B. A. (2023). Damage control resuscitation in adult trauma patients. Journal of Intensive Care Medicine, 38(12), 1121–1130.
10. Leibner, E., Andreae, M., Galvagno, S. M., & Scalea, T. (2020). Damage control resuscitation. Clinical and Experimental Emergency Medicine, 7(1), 5–13.
11. Maas, A. I. R., Menon, D. K., Manley, G. T., Abrams, M., Åkerlund, C., Andelic, N., et al. (2022). Traumatic brain injury: Progress and challenges in prevention, clinical care, and research. The Lancet Neurology, 21(11), 1004–1060. https://doi.org/10.1016/S1474-4422(22)00309-X
12. Meyfroidt, G., Bouzat, P., Casaer, M. P., Chesnut, R., Hamada, S. R., Helbok, R., et al. (2022). Management of moderate to severe traumatic brain injury: An update for the intensivist. Intensive Care Medicine, 48, 649–666.
13. Ordoñez, C. A., Pino, L. F., Badiel, M., Sánchez, A. I., Loaiza, J., Ballestas, L., et al. (2016). Trauma Registry of the Pan-American Trauma Society: One year of experience in two hospitals in southwest Colombia. Colombia Médica, 47(3), 148–154.
14. Peng, H. T. (2020). Hemostatic agents for prehospital hemorrhage control: A narrative review. Military Medical Research, 7, 13.
15. Riedy, G., Senseney, J. S., Liu, W., Ollinger, J., Sham, E., Krapiva, P., et al. (2016). Findings from structural MR imaging in military traumatic brain injury. Radiology, 279(1), 207–215.
16. Rojas, L. G. P., Moore, E. E., Pino, L. F., & Coimbra, R. (2023). Latin America trauma systems—Mexico and Brazil. Current Trauma Reports, 9, 137–144.
17. Rossaint, R., Afshari, A., Bouillon, B., Cerny, V., Cimpoesu, D., Curry, N., et al. (2023). The European guideline on management of major bleeding and coagulopathy following trauma: Sixth edition. Critical Care, 27, 80. https://doi.org/10.1186/s13054-023-04327-7
18. Shackelford, S. A., Butler, F. K., Kragh, J. F., Stevens, R. A., Seery, J. M., Parsons, D. L., et al. (2015). Optimizing the use of limb tourniquets in Tactical Combat Casualty Care: TCCC Guidelines Change 14-02. Journal of Special Operations Medicine, 15(1), 17–31.
19. Welch, M., Barratt, J., Peters, A., & Wright, C. (2020). Systematic review of prehospital haemostatic dressings. BMJ Military Health, 166(3), 194–200.
20. Wintermark, M., Sanelli, P. C., Anzai, Y., Tsiouris, A. J., & Whitlow, C. T. (2015). Imaging evidence and recommendations for traumatic brain injury: Advanced neuro- and neurovascular imaging techniques. AJNR American Journal of Neuroradiology, 36(2), E1–E11.
