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experience with combat tourniquets 6. Walters TJ, Wenke JC, Greydanus DJ, Kauver DS, Baer DG.
than any military force in history . . . Laboratory Evaluation of Battlefield Tourniquets in Human
Volunteers. USAISR Report 2005–05. San Antonio, TX: U.S.
Army Institute of Surgical Research; 2005.
7. Butler FK, Greydanus D, Holcomb J. Combat Evaluation of
bringing about the highest casualty survival rate in his- TCCC Techniques and Equipment: 2005. USAISR Report
tory: our courageous combat medical personnel, who 2006–01. San Antonio, TX: U.S. Army Institute of Surgical
perform amazing feats of medical care in the midst of the Research; November 2006.
battle; the helicopter evacuation crews, who willingly 8. Kragh JF, Walters TJ, Baer DG, et al. Practical use of emer-
risk their lives over and over to evacuate our casualties gency tourniquets to stop bleeding in major limb trauma. J
Trauma. 2008;64(suppl 2):S38–S50.
to safety; the superbly skilled surgical and intensive care 9. Eastridge BJ, Mabry RL, Seguin P, et al. Prehospital death
teams in our hospitals; the Critical Care Air Transport on the battlefield (2001–2011): Implications for the future of
Teams that fly desperately ill casualties thousands of combat casualty care. J Trauma Acute Care Surg. 2012;73(6
miles to higher levels of care; the rehabilitation special- suppl 5):S431–S437.
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RF. Understanding combat casualty care statistics. J Trauma.
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finally, the professionals at the Joint Trauma System, 11. Kotwal RS, Montgomery HR, Kotwal BM, et al. Elimi-
who work ceaselessly to provide oversight of the entire nating preventable death on the battlefield. Arch Surgery.
system and make it function smoothly. To all these men 2011;146(12):1350–1358.
and women, our nation owes a great debt. 12. Wedmore I, McManus JG, Pusateri AE, Holcomb JB. A spe-
cial report on the chitosan-based hemostatic dressing: expe-
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Because most combat fatalities occur in the prehospital 655–658.
phase of care, our nation’s combat medical providers 13. Rhee P, Brown C, Martin M, et al. QuikClot use in trauma
play an especially important role in ensuring the high- for hemorrhage control: case series of 103 documented uses.
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est casualty-survival rate possible. The TCCC has given 14. Kheirabadi B, Mace J, Terrazas I, et al. Safety evaluation of
these individuals a vastly improved set of tools and skills new hemostatic agents, smectite granules, and kaolin-combat
to better accomplish their heroic and lifesaving deeds gauze in a vascular injury wound model in swine. J Trauma.
on the battlefield, and tourniquets and hemostatic dress- 2010;68(2):269–278.
ings are now a permanent fixture in their aid bags. 15. Ran Y, Hadad E, Daher S, et al. QuikClot combat gauze for
hemorrhage control in military trauma: January 2009 Israel
Defense Force experience in the Gaza Strip—a preliminary re-
ACTIVE SHOOTER INCIDENTS: 2000–2013 port of 14 cases. Prehosp Disaster Med. 2010;25(6):584–588.
DURATION OF ACTIVE SHOOTER INCIDENTS 16. Rall JM, Cox JM, Songer A, et al. Naval Medical Research
Unit San Antonio. Comparison of novel hemostatic gauzes
• 44 (69%) ended in 5 minutes or less to QuikClot combat gauze in a standardized swine model of
• 23 ended in 2 minutes or less uncontrolled hemorrhage. Technical Report 2012–22. March
23, 2012. Available at: www.medicalsci.com/files/ tccc_rall
• Civilians had to make life-or-death decisions and _new_hemostatic_gauzes_namru-sa_tr_2012–22.pdf. Accessed
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*Note: This is in 64 incidents in which the duration could be
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152 Journal of Special Operations Medicine Volume 15, Edition 4/Winter 2015