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In the intervening years, evidence has amassed indicating that the HES fluids may not be safe, and in June 2013 the US Food and Drug Administration issued a warning that HES solutions should not be used to treat patients with hypovolaemia or the critically ill. We review the unique challenges of early battlefield resuscitation, why the \u2018Bellamy challenge\u2019 remains open and discuss a number of forward-looking strategies that may help to solve the problem. The first two pillars of resuscitation that we believe have not been adequately addressed are rescuing and stabilising the heart (and brain) and the vascular system. The \u2018ideal\u2019 resuscitation fluid needs to nurture the heart and body slowly back to health, and not \u2018shock\u2019 it a second time with unnatural colloids or large volumes of unphysiological saline-based solutions.<\/jats:p>","DOI":"10.1136\/jramc-2013-000145","type":"journal-article","created":{"date-parts":[[2013,10,19]],"date-time":"2013-10-19T01:10:41Z","timestamp":1382145041000},"page":"9-15","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":10,"title":["The Bellamy challenge: it's about time"],"prefix":"10.1136","volume":"160","author":[{"given":"Geoffrey P","family":"Dobson","sequence":"first","affiliation":[{"name":"Department of Physiology and Pharmacology, Heart and Trauma Research Laboratory, James Cook University, Townsville, Queensland, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"H L","family":"Letson","sequence":"additional","affiliation":[{"name":"Department of Physiology and Pharmacology, Heart and Trauma Research Laboratory, James Cook University, Townsville, Queensland, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"D","family":"Tadaki","sequence":"additional","affiliation":[{"name":"Department of Physiology and Pharmacology, Heart and Trauma Research Laboratory, James Cook University, Townsville, Queensland, Australia"},{"name":"Department of Regenerative Medicine, Naval Medical Research Center, Silver Spring, Maryland, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2013,10,18]]},"reference":[{"key":"2025081315121981000_160.1.9.1","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0b013e31817da7dc"},{"issue":"(2 Suppl 2)","key":"2025081315121981000_160.1.9.2","first-page":"S270","article-title":"Prevention of infections associated with combat-related thoracic and abdominal cavity injuries","volume":"71","author":"Martin","year":"2011","journal-title":"J Trauma"},{"key":"2025081315121981000_160.1.9.3","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1093\/milmed\/149.2.55","article-title":"The causes of death in conventional land warfare: implications for combat casualty care research","volume":"149","author":"Bellamy","year":"1984","journal-title":"Mil Med"},{"key":"2025081315121981000_160.1.9.4","unstructured":"WHO. 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