{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,3]],"date-time":"2026-11-03T06:18:46Z","timestamp":1793686726353,"version":"4.5.1"},"reference-count":129,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2021,10,10]],"date-time":"2021-10-10T00:00:00Z","timestamp":1633824000000},"content-version":"unspecified","delay-in-days":9,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"DRDC","award":["Task 47 under a research contract W7714-145967"],"award-info":[{"award-number":["Task 47 under a research contract W7714-145967"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Trauma Surg Acute Care Open"],"accepted":{"date-parts":[[2021,7,27]]},"published-print":{"date-parts":[[2021,10]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>The Tactical Combat Casualty Care (TCCC) guidelines detail resuscitation practices in prehospital and austere environments. We sought to review the content and quality of the current TCCC and civilian prehospital literature and characterize knowledge gaps to offer recommendations for future research.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>MEDLINE, EMBASE, CINAHL, and Cochrane Central Register of Controlled Trials were searched for studies assessing intervention techniques and devices used in civilian and military prehospital settings that could be applied to TCCC guidelines. Screening and data extraction were performed according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Quality appraisal was conducted using appropriate tools.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Ninety-two percent (n=57) of studies were observational. Most randomized trials had low risk of bias, whereas observational studies had higher risk of bias. Interventions of massive hemorrhage control (n=17) were wound dressings and tourniquets, suggesting effective hemodynamic control. Airway management interventions (n=7) had high success rates with improved outcomes. Interventions of respiratory management (n=12) reported low success with needle decompression. Studies assessing circulation (n=18) had higher quality of evidence and suggested improved outcomes with component hemostatic therapy. Hypothermia prevention interventions (n=2) were generally effective. Other studies identified assessed the use of extended focused assessment with sonography in trauma (n=3) and mixed interventions (n=2).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The evidence was largely non-randomized with heterogeneous populations, interventions, and outcomes, precluding robust conclusions in most subjects addressed in the review. Knowledge gaps identified included the use of blood products and concentrate of clotting factors in the prehospital setting.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of evidence<\/jats:title>\n                    <jats:p>Systematic review, level III.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/tsaco-2021-000773","type":"journal-article","created":{"date-parts":[[2021,10,19]],"date-time":"2021-10-19T16:15:15Z","timestamp":1634660115000},"page":"e000773","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":29,"title":["Evaluating the Tactical Combat Casualty Care principles in civilian and military settings: systematic review, knowledge gap analysis and recommendations for future research"],"prefix":"10.1136","volume":"6","author":[{"given":"Rachel","family":"Strauss","sequence":"first","affiliation":[{"name":"Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabella","family":"Menchetti","sequence":"additional","affiliation":[{"name":"Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laure","family":"Perrier","sequence":"additional","affiliation":[{"name":"Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erik","family":"Blondal","sequence":"additional","affiliation":[{"name":"Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henry","family":"Peng","sequence":"additional","affiliation":[{"name":"Defence Research and Development Canada, Toronto Research Centre, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wendy","family":"Sullivan-Kwantes","sequence":"additional","affiliation":[{"name":"Defence Research and Development Canada, Toronto Research Centre, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Homer","family":"Tien","sequence":"additional","affiliation":[{"name":"Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Avery","family":"Nathens","sequence":"additional","affiliation":[{"name":"Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Beckett","sequence":"additional","affiliation":[{"name":"Department of Surgery, St Michael's Hospital, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeannie","family":"Callum","sequence":"additional","affiliation":[{"name":"Laboratory Medicine and Molecular Diagnostics, Kingston Health Sciences Centre, Kingston, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luis Teodoro","family":"da Luz","sequence":"additional","affiliation":[{"name":"Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2021,10,19]]},"reference":[{"key":"2025081710574968000_6.1.e000773.1","doi-asserted-by":"crossref","first-page":"e1563","DOI":"10.7205\/MILMED-D-16-00214","article-title":"Two decades of saving lives on the battlefield: tactical combat casualty care turns 20","volume":"182","author":"Butler","year":"2017","journal-title":"Mil Med"},{"key":"2025081710574968000_6.1.e000773.2","doi-asserted-by":"crossref","first-page":"S14","DOI":"10.1097\/TA.0000000000002200","article-title":"The \"Top 10\" research and development priorities for battlefield surgical care: Results from the Committee on Surgical Combat Casualty Care research gap analysis","volume":"87","author":"Martin","year":"2019","journal-title":"J Trauma Acute Care Surg"},{"key":"2025081710574968000_6.1.e000773.3","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.b2700","article-title":"The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration","volume":"339","author":"Liberati","year":"2009","journal-title":"BMJ"},{"key":"2025081710574968000_6.1.e000773.4","unstructured":"Department of Defense Center of Excellence for Trauma . 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