Exsanguination is the single most common cause of death on the battlefield; therefore the prevention of exsanguination at or near the point of wounding must be the single most important medical task. No hospital, no matter how advanced, and no surgeon, no matter how skilled, can save a wounded patient who has exsanguinated. Thus it is true, as Dr. Nicholas Senn, founder of the Associa-tion of Military Surgeons of the United States, once said, "The fate of the wounded lies in the hands of the ones who apply the first dressing." Most of those who die on the battlefield do so within minutes of wounding. Few of these patients with rapidly exsanguinating wounds can be saved regardless of the level of care provided; most would die even if they were wounded right out-side a Level I trauma center. As noted by Col. Gray during World War I, "The haemorrhage that takes place when a main artery is divided is usually so rapid and so copious that the wounded man dies before help can reach him."

Furthermore, a sizeable number who could have been saved had care been immediately available die because the circumstances of combat preclude the rapid delivery of such care. An analysis of 98 Vietnam casualties who died from exsanguination revealed that nearly 20% had sustained injuries that, in ideal circumstances, could have been controlled with a tourniquet and/or appropriately applied direct pressure.5-7 But some casualties with potentially lethal hemorrhage can be saved and it is upon this group the combat medical provider must focus.