The commonest cause of avoidable mortality in combat is haemorrhage.  Recent conflict involving western forces has seen an upsurge in active management of bleeding.  This starts at site of wounding, with application of tourniquets and haemostatic dressings.  Active resuscitation continues during transport to a care facility, with early intravenous access allowing administration of tranexamic acid and fibrinogen.  Other fluids are kept to a minimum, resuscitating only to a point where a peripheral pulse can be felt.  Other measures include airway support, oxygen therapy and analgesia. In the shocked patient, measures to prevent acidosis and hypothermia are actively provided, even during transport, usually by helicopter.

Once at a care facility, usually a Role 2, blood therapy can be personalised using point of care testing.  Component therapy is instituted early, with the separate use of red blood cells, plasma products and platelets. 

These measures are now familiar to practising obstetricians, but what may not be realised is that they have been developed at an accelerated pace by military doctors from NATO forces (in particular the UK and the USA).  The current practitioners par excellence are the Dutch, and they now provide the blood service expertise for many larger allied nations, including Germany and Scandinavia.

It is hard to predict the future of aggressive resuscitation, both on the battlefield and in delivery suite, but I would hazard a guess that we are not far from using erythropoietin early in shocked patients.  (This must be considered experimental at this stage!)