The Rise of the Military in Pre-Hospital Care

In 2012, London Air Ambulance in the UK started to carry packed red cells. The service believed hundreds of lives could be saved and regional services were looking to follow suit. Refill is not a primary outcome but I would challenge anybody in this room to come up with a nice one that reflects the trial results. Lactate clearance is the best surrogate for quality of resuscitation at the end of the pre-hospital phase. A well perfused tissue doesn't generate oxygenated liver which will clear lactate so if you are shocked you're still going to get shock.