To improve outcomes from traumatic hemorrhagic shock by optimizing the acute phase of resuscitation.
To develop and implement best practices for prehospital care through to the completion of the acute phase of hemorrhagic shock resuscitation.
The THOR Network will execute this mission through a multidisciplinary collaborative approach to research, education, training, and advocacy
Battlefield resuscitation of hemorrhagic shock are constrained by many limitations in combat settings. Resuscitation strategy is changing towards early use of blood components and hemostatic agents. Dr. Geir Strandenes was employed as a medical director on unit level in the Norwegian Navy in 2010. He has since devoted much of his time to further develop this strategy together with Dr. Philip Spinella, Prof. Tor Hervig and CM Håkon Eliassen. The project was named Blood Far Forward and in order to consolidate and gather knowledge throughout the world we have formed a network:
THOR – The Hemostasis and Oxygenation Research Network
The Traumatic Hemostasis and Oxygenation Research (THOR) Network is a international multidisciplinary group of investigators with a common interest in performing research that aims to improve outcomes and safety in patients with severe traumatic injury through improved monitoring and resuscitation techniques. The Network’s focus on the optimal methods to identify and treat traumatic shock and coagulopathy are evidenced by its current work on advancing the measurement of tissue oxygenation, cellular shock, clot strength, and fibrinolysis as well as determining the optimal fluid and blood products that are needed for these patients. The research the Network performs includes both pre-hospital and hospital phases of care with attention to both military and civilian applications.
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What is RDCR?
“RDCR is a concept envisioned for the use in the out of hospital combat casualty care setting,in cases where severely wounded casualty with continuing non compressible torso hemorrhage (NCTH) face delays in evacuation to resuscitative surgical intervention. RDCR can also be applied for severe civilian trauma especially for circumstances where there are prolonged evacuation times. RDCR is anchored in the principles of Tactical Combat Casualty Care (TCCC), beginning with the identification of life-threatening conditions followed by the appropriate and timely performance of Life Saving Interventions (LSI) before tactical evacuation, with care continuing en route to resuscative surgery and theater hospitalization. In cases of NCTH when standard prehopital intervention have been exhausted, the RDCR algorithm would seek to further mitigate end-organ hypoxia and the” lethal triage” through the judicious employment of blood products,procoagulants and antifibrinolytic agents by far-forward combat medical personnel, leveraging remote decisions support technology and emergency telemedical reach- back to a specialist capable of providing informed medical direction.”
Analysis of Life-Saving Interventions Performed by Out-of-Hospital Combat Medical Personnel
Robert T. Gerhardt, MD, MPH, FACEP, Johnathon A. Berry, DO, and Lorne H. Blackbourne, MD, FACS
About the RDCR Symposium
The Trauma Hemostasis and Oxygenation Research (THOR) Network held it’s first RDCR symposium in June 2011. It was a one-day symposium focusing on pre-hospital use of fresh whole blood. The objective of this meeting was to bring together investigators who were interested in analyzing the efficacy and safety of FWB for patients with severe traumatic hemorrhagic shock and to determine the initial steps in developing a research program in this area. A report from this inaugural symposium titled, “Symposium on Fresh Whole Blood for Severe Hemorrhagic Shock: From in-hospital to far forward resuscitations” was published in the journal Transfusion and Apheresis Science in 2012.
In 2012 the RDCR symposium expanded to 3 days, with the focus remaining on pre-hospital management of life threatening hemorrhage. Specifically the symposium focused on research improving the monitoring and treatment of hemorrhagic shock from trauma. A 144 page supplement summarizing 20 presentations from the 2012 RDCR Symposium is in press in Transfusion.
Previous Symposia have included an international group of both Military and Civilian leaders in trauma and resuscitation translational and basic research science. Representatives from 18 countries, and 4 continents participated in the symposium.