PURPOSE: To review potential clinical uses of erythrocyte substitutes in treating military battlefield casualties, with specific emphasis on combat injury rates and wounding patterns, resuscitation doctrine and logistic requirements. METHODS: Review of published medical literature and of unclassified documents from the U.S. Armed Forces Blood Program. RESULTS: Hemorrhage is the leading cause of death on the battlefield. Early intervention, with definitive treatment, could save up to 30% of soldiers who are killed in action or who die of wounds. Hemorrhage control and rapid volume expansion in appropriate casualties are the main priorities in pre-hospital resuscitation of battlefield casualties. The role for oxygen-carrying fluids in the initial management of military injuries is undefined; however, erythrocyte substitutes could reduce the logistic requirements for blood in field hospitals. In recent wars, outdating of stored blood resulted in 60-95% of units being discarded: 60% of 1.3 million units in Vietnam and 95% of 120,000 units in the Persian Gulf War. CONCLUSIONS: Safety, long storage life, light unit weight, and tolerance to environmental extremes are all characteristics that are necessary for erythrocyte substitutes to extend or replace the use of stored blood in treating battlefield casualties.
