The Bellamy challenge: it's about time

@article{Dobson2014TheBC,
  title={The Bellamy challenge: it's about time},
  author={Geoffrey P. Dobson and Harry Letson and Douglas K. Tadaki},
  journal={Journal of the Royal Army Medical Corps},
  year={2014},
  volume={160},
  pages={15 - 9}
}
In 1984, Col. Ronald Bellamy launched a worldwide challenge to develop a new resuscitation fluid to aid survival after catastrophic blood loss on the battlefield. In 1996, after careful compromise among need, cube weight and efficacy, the US military and later coalition forces adopted 6% hetastarch (HES) fluids for early resuscitation. 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… 
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References

SHOWING 1-10 OF 136 REFERENCES
Current concepts in fluid resuscitation for prehospital care of combat casualties.
  • M. Dubick
  • Medicine
    U.S. Army Medical Department journal
  • 2011
TLDR
Damage control resuscitation recommends limiting the amount of crystalloids or colloids infused and using plasma and other blood products in more optimal ratios for the treatment of severe hemorrhage to improve battlefield survival and to reduce or prevent early and late deleterious sequelae.
Damage control resuscitation: a sensible approach to the exsanguinating surgical patient.
TLDR
This strategy, called "damage control resuscitation", includes the use of permissive hypotension; the prevention and aggressive treatment of hypothermia with both passive and active warming measures; the temporization of acidosis with use of exogenous buffer agents.
FLUID RESUSCITATION: PAST, PRESENT, AND THE FUTURE
TLDR
The historical development and scientific underpinnings of modern resuscitation techniques are reviewed and some novel resuscitation strategies aimed at preventing or ameliorating cellular injury may become clinically available in the future are described.
State of the art of fluid resuscitation 2010: prehospital and immediate transition to the hospital.
TLDR
Although discussions focused on military needs, it was understood and accepted by the consensus group that many, if not all, of the recommendations could and would be used for civilian prehospital providers with appropriate situational modifications.
Resuscitation from severe hemorrhage.
TLDR
Clinical potentials in need of research are shifting from normotensive to hypotensive (limited) fluid resuscitation with plasma substitutes, and animal outcome models of combined trauma and shock are needed; a challenge is to find a humane and clinically realistic long-term method for analgesia that does not interfere with cardiovascular responses.
Eliminating preventable death on the battlefield.
TLDR
A command-directed casualty response system that trains all personnel in Tactical Combat Casualty Care and receives continuous feedback from prehospital trauma registry data facilitated performance improvements that resulted in unprecedented reduction of killed-in-action deaths, casualties who died of wounds, and preventable combat death.
Tactical combat casualty care 2007: evolving concepts and battlefield experience.
The Tactical Combat Casualty Care (TCCC) project begun by the Naval Special Warfare Command and continued by the U.S. Special Operations Command developed a set of tactically appropriate battlefield
ROC trials update on prehospital hypertonic saline resuscitation in the aftermath of the US-Canadian trials
The objectives of this review are to assess the current state of hypertonic saline as a prehospital resuscitation fluid in hypotensive trauma patients, particularly after the 3 major Resuscitation
...
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4
5
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