Anti-shock therapy for combat trauma in the pre-hospital setting: modern approaches and pathophysiological rationales

Authors

DOI:

https://doi.org/10.14739/mmt.2026.2.349696

Keywords:

combat trauma, hemorrhagic shock, prehospital care, Damage Control Resuscitation, anti-shock therapy

Abstract

Trauma remains one of the leading causes of mortality and long-term disability worldwide, and in the context of ongoing full-scale hostilities in Ukraine has acquired exceptional medical, and social significance. Massive hemorrhage and the development of hemorrhagic shock are the main causes of death among the wounded during, underscoring the need for contemporary, pathophysiologically grounded approaches to anti-shock therapy.

The aim of this work is to summarize and provide a pathophysiological analysis of modern approaches to prehospital anti-shock therapy for combat trauma, in accordance with the Damage Control Resuscitation concept.

Materials and methods. The study was based on a systematic review and critical analysis of current scientific publications from PubMed, Scopus, Web of Science, and the Cochrane Library, as well as international tactical medicine guidelines, including the Tactical Combat Casualty Care recommendations.

Results. Modern concepts of the pathogenesis of hemorrhagic shock in combat trauma are summarized through the lens of the “lethal triad” and the expanded “diamond of death”. It is demonstrated that early hemorrhage control, restricted fluid therapy, hemostatic resuscitation with blood components, prevention of hypothermia, correction of hypocalcemia, and adequate analgesia are interrelated components of effective prehospital care. Particular emphasis is placed on the role of tranexamic acid as a pathogenetically justified agent for early correction of traumatic coagulopathy. The rationale for its administration at the prehospital stage is substantiated, taking into account the critical time-dependence of its clinical efficacy.

Conclusions. Integration of Damage Control Resuscitation principles into prehospital care protocols for combat trauma reduces physiological decompensation, lowers mortality, and improves outcomes at subsequent stages of treatment and medical evacuation. Further advancement of military medicine should focus on the standardization and practical implementation of comprehensive anti-shock algorithms adapted to the realities of combat operations.

Author Biographies

L. M. Soltysik, Ivano-Frankivsk National Medical University

MD, Senior Lecturer of the Department of Disaster Medicine and Military Medicine

I. V. Zarivna, Ivano-Frankivsk National Medical University

MD, Lecturer at the Department of Disaster Medicine and Military Medicine

References

  1. Injuries and violence [Internet]. Who.int. [cited 2026 Jan 22]. Available from: https://www.who.int/news-room/fact-sheets/detail/injuries-and-violence
  2. United Nations Human Rights Monitoring Mission in Ukraine. Protection of civilians in armed conflict Ukraine: October 2025 update. Kyiv: OHCHR; 2025 Dec. Available from: https://ukraine.ohchr.org/uk/reports
  3. Welker K. Zelenskyy outlines his vision for peace talks, NATO’s future and what he would say to Putin. Meet the Press. New York (NY): NBC News; 2025 Feb 16 Available from: https://surl.lu/mnbtmq
  4. Latif RK, Clifford SP, Baker JA, Lenhardt R, Haq MZ, Huang J, et al. Traumatic hemorrhage and chain of survival. Scand J Trauma Resusc Emerg Med. 2023;31(1):25. doi: https://doi.org/10.1186/s13049-023-01088-8
    | |
  5. Souza LP, Ribeir P, Santos R, Moreira RF de F, Lima P, Araujo L. Damage Control Resuscitation: Evidence-based systematic review for treating traumatized patients. J Adv Med Med Res. 2024;36(6):343-9. doi: https://doi.org/10.9734/jammr/2024/v36i65477
  6. Rotondo MF, Schwab CW, McGonigal MD, Phillips GR 3rd, Fruchterman TM, Kauder DR, et al. ‘Damage control’: an approach for improved survival in exsanguinating penetrating abdominal injury. J Trauma. 1993;35(3):375-82; discussion 382-3.
    | |
  7. Jarrassier A, Boutonnet M, Duranteau J, Travers S, Prat N, Dubourg O, et al. Initial management of haemorrhagic war casualties: tactical priorities and innovative approaches in modern and future warfare. Crit Care. 2025;29(1):509. doi: https://doi.org/10.1186/s13054-025-05752-6
    | |
  8. Burch JM, Ortiz VB, Richardson RJ, Martin RR, Mattox KL, Jordan GL Jr. Abbreviated laparotomy and planned reoperation for critically injured patients. Ann Surg. 1992;215(5):476-83; discussion 483-4. doi: https://doi.org/10.1097/00000658-199205000-00010
    | |
  9. Mehr N, Fong E, Carll T. Citrate & Hypocalcemia in Massive Transfusion. Med Res Arch. 2025;13(8). doi: https://doi.org/10.18103/mra.v13i8.6869
  10. Rossaint R, Afshari A, Bouillon B, Cerny V, Cimpoesu D, Curry N, et al. The European guideline on management of major bleeding and coagulopathy following trauma: sixth edition. Crit Care. 2023;27(1):80. doi: https://doi.org/10.1186/s13054-023-04327-7
    | |
  11. Palitnonkiat V, Thampongsa T, Sirikun J, Owattanapanich N. Association between hypocalcemia and mortality in trauma patients: a systematic review and meta-analysis. Trauma Surg Acute Care Open. 2025;10(4):e001800. doi: https://doi.org/10.1136/tsaco-2025-001800
    | |
  12. Deaton TG, Drew B, Montgomery HR, Butler FK Jr. Tactical Combat Casualty Care (TCCC) Guidelines: 25 January 2024. J Spec Oper Med. 2024;24(1):100-8. doi: https://doi.org/10.55460/QT3B-XK5B
    | |
  13. Fulton II MR, Schwartfeger S. EMS Tactical Damage Control Resuscitation Protocol. [Updated 2024 Jan 11]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026. Available from: https://www.ncbi.nlm.nih.gov/books/NBK599525/
  14. Epstein D, Radimislensky I, Lipsky AM, Minha S, Kiso S, Sagie Y, et al. Assessing the evolution of pre-hospital combat casualty care: A comparative study of two conflicts a decade apart. Am J Emerg Med. 2025;88:96-104. doi: https://doi.org/10.1016/j.ajem.2024.11.077
    | |
  15. Berry C, Gallagher JM, Goodloe JM, Dorlac WC, Dodd J, Fischer PE. Prehospital Hemorrhage Control and Treatment by Clinicians: A Joint Position Statement. Prehosp Emerg Care. 2023;27(5):544-51. doi: https://doi.org/10.1080/10903127.2023.2195487
    | |
  16. Guyette FX, Sperry JL, Peitzman AB, Billiar TR, Daley BJ, Miller RS, et al. Prehospital Blood Product and Crystalloid Resuscitation in the Severely Injured Patient: A Secondary Analysis of the Prehospital Air Medical Plasma Trial. Ann Surg. 2021;273(2):358-64. doi: https://doi.org/10.1097/SLA.0000000000003324
    | |
  17. Rahmadian R, Evlin Margaretha R, Ariliusra Z, Milfiadi H. Fluid resuscitation and trauma management: Permissive hypotension, restricted volume, and beyond. J Endovasc Resusc Trauma Manag. 2024;8(3):65-73. doi: http://doi.org/10.26676/jevtm.26617
    |
  18. Deaton TG, Auten JD, Betzold R, Butler FK Jr, Byrne T, Cap AP, et al. Fluid Resuscitation in Tactical Combat Casualty Care; TCCC Guidelines Change 21-01. 4 November 2021. J Spec Oper Med. 2021;21(4):126-37. doi: https://doi.org/10.55460/JYLU-4OZ8
    | |
  19. Chen HY, Wu LG, Fan CC, Yuan W, Xu WT. Effectiveness and safety of prehospital tranexamic acid in patients with trauma: an updated systematic review and meta-analysis with trial sequential analysis. BMC Emerg Med. 2024;24(1):202. doi: https://doi.org/10.1186/s12873-024-01119-2
    | |
  20. Li Y, Tian M, Zhong W, Zou J, Duan X, Si H. Prehospital tranexamic acid decreases early mortality in trauma patients: a systematic review and meta-analysis. Front Med (Lausanne). 2025;12:1552271. doi: https://doi.org/10.3389/fmed.2025.1552271
    | |
  21. Thomas HM, Kahf H, Bush B, Nahmias J, Lim PK. Use of tranexamic acid in trauma surgical specialties: a narrative review. World J Emerg Surg. 2025;20(1):76. doi: https://doi.org/10.1186/s13017-025-00649-9
    | |
  22. Dumas RP, Succar BE, Vella MA, Appelbaum RD, Neal MD, Dultz La, et al. The use of tranexamic acid in the management of injured patients at risk of hemorrhage: a systematic review and meta-analysis and an Eastern Association for the Surgery of Trauma Practice Management Guideline. J Trauma Acute Care Surg. 2025;99(5):785-94. doi: https://doi.org/10.1097/TA.0000000000004773
    | |
  23. Singh S, Krishna VS, Peter DK. An Insight into Damage Control Resuscitation and its Application in the Modern Battlefield: A Military Perspective. J Emerg Trauma Shock. 2025;18(3):131-7. doi: https://doi.org/10.4103/jets.jets_154_24
    | |
  24. Barrett WJ, Kaucher KA, Orpet RE, Campion EM, Goodloe JM, Fischer PE, et al. Tranexamic acid in trauma: A joint position statement and resource document of NAEMSP, ACEP, and ACS-COT. J Trauma Acute Care Surg. 2025;99(3):357-63. doi: https://doi.org/10.1097/TA.0000000000004727
    | |
  25. TCCC. Module 12: Hypothermia prevention & treatment. CoTCCC; 2024. Available from: https://tccc.org.ua/en/guide/module-12-hypothermia-prevention-treatment-cmc
  26. Wray JP, Bridwell RE, Schauer SG, Shackelford SA, Bebarta VS, Wright FL, et al. The diamond of death: Hypocalcemia in trauma and resuscitation. 29*Am J Emerg Med. 2021;41:104-9. doi: https://doi.org/10.1016/j.ajem.2020.12.065
    | |
  27. de Grunt MN, de Jong B, Hollmann MW, Ridderikhof ML, Weenink RP. Parenteral, Non-Intravenous Analgesia in Acute Traumatic Pain-A Narrative Review Based on a Systematic Literature Search. J Clin Med. 2024;13(9):2560. doi: https://doi.org/10.3390/jcm13092560
    | |

Downloads

Additional Files

Published

2026-06-09

How to Cite

Soltysik, L. M., & Zarivna, I. V. (2026). Anti-shock therapy for combat trauma in the pre-hospital setting: modern approaches and pathophysiological rationales. Modern Medical Technology, 18(2), 129–134. https://doi.org/10.14739/mmt.2026.2.349696

Issue

Vol. 18 No. 2 (2026)

Section

Reviews of literature

License

Copyright (c) 2026 L. M. Soltysik, I. V. Zarivna

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

The work is provided under the terms of the Public Offer and of Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0). This license allows an unlimited number of persons to reproduce and share the Licensed Material in all media and formats. Any use of the Licensed Material shall contain an identification of its Creator(s) and must be for non-commercial purposes only.