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[Comment] No gains with plasma-first resuscitation in urban settings?

In 1943, during World War 2, Major General Norman Kirk, the Surgeon General of the US Army, was asked by the American Medical Association what was responsible for the higher-than-expected survival among soldiers wounded in combat. He quickly replied, “The foremost lifesaver is plasma…without that, many men would have died.” From a physiological perspective it makes sense to give blood products as early as possible to patients with traumatic haemorrhagic shock, and these are thought to be superior to crystalloid fluids during remote damage control resuscitation1 and for civilian major trauma.