External Hemorrhage Control Techniques for Human Space Exploration: Lessons from the Battlefield

Abstract

The past few decades of military experience have brought major advances in the prehospital care of patients with trauma. A focus on early hemorrhage control with aggressive use of tourniquets and hemostatic gauze is now generally accepted. This narrative literature review aims to discuss external hemorrhage control and the applicability of military concepts in space exploration. In space, environmental hazards, spacesuit removal, and limited crew training could cause significant time delays in providing initial trauma care. Cardiovascular and hematological adaptations to the microgravity environment are likely to reduce the ability to compensate, and resources for advanced resuscitation are limited. Any unscheduled emergency evacuation requires a patient to don a spacesuit, involves exposure to high G-forces upon re-entry into Earth's atmosphere, and costs a significant amount of time until a definitive care facility is reached. As a result, early hemorrhage control in space is critical. Safe implementation of hemostatic dressings and tourniquets seems feasible, but adequate training will be essential, and tourniquets are preferably converted to other methods of hemostasis in case of a prolonged medical evacuation. Other emerging approaches such as early tranexamic acid administration and more advanced techniques have shown promising results as well. For future exploration missions to the Moon and Mars, when evacuation is not possible, we look into what training or assistance tools would be helpful in managing the bleed at the point of injury.

Managing Hemostasis in Space

“…A series of excellent reviews on the topic of external hemorrhage control and emergency surgery in space supports that most diagnostic maneuvers, resuscitative, and surgical interventions required to treat a bleeding astronaut are technically feasible, but quite challenging in the microgravity environment. [62][63][64][65][66] Feasibility of hemostatic surgical procedures was also confirmed in animal models during the Neurolab space shuttle mission. 67 Surgeons have successfully performed damage control surgical procedures using torso hemorrhage simulators during parabolic flight.…”

The Year in Review

“…In the spirit of innovation, both Weinstein and Thoolen delivered manuscripts that were forward thinking. 11,12 Weinstein’s commentary introduced a thematic international issue on toxinology and explored both the immediate clinical significance of envenomation, as well as innovations in treatment for snake bites in Sri Lanka and wasp stings in China. Thoolen and others provided an inspiring review article on the burgeoning space industry, considered by some as the fourth Industrial Revolution, and the use of external hemorrhage control techniques.…”