Figure 2.

Proposed Use of VHA for Hemorrhagic Resuscitation in the Far-Forward Combat Environment. The hemorrhaging soldier is initially transfused WB (or fixed ratio) according to military protocol and blood product availability. While being resuscitated and prior to evacuation, the medics may obtain a blood sample and start the viscoelastic hemostatic assay (VHA). While the patient is en route to the Battalion Aid Station, the VHA result from the far-forward is transmitted to the Battalion Aid Station. Here, the far-forward VHA result—as well as a new VHA at the Battalion Aid Station—may guide goal-directed blood-component therapy. If the patient is to be transported further, the prior VHA results may be transmitted to the Combat Support Hospital. At the Combat Support Hospital, all future transfusions are guided by adjunctive VHA results to treat the patient’s individual hemostatic phenotype.