specialists such as Physiotherapists and Speech Therapists who can quickly and efficiently draw up a personalized rehabilitation plan (1) . This is a clear example of a military advance in the field translating into civilian circumstances and improving healthcare. Furthermore the introduction of Trauma Centres also allowed for the introduction of the Rapid Resuscitation Pathway (RRP). This Technique, developed in 2005 at Camp Bastion and introduced in 2013 at St Mary's Trauma Centre involves patients bypassing the resuscitation room and going straight to theatre, thereby reducing what is called the ‘knife to skin’ time (4) . This is the term given for the time taken from a patient's arrival at a centre to the surgery which could potentially save them. This treatment is only possible with Trauma Centres, as they can run full 24 hour operating theatres. They have the specialists required (e.g. Senior Surgeons) and the Theatre Team can be briefed up with specific action cards while the casualty is on route, due to the information given by staff on the Trauma Network. This yields much higher survival rates, contributing to the new figure that UK patients are now 20% more likely to survive Major Trauma since the introduction of Trauma Centres (figures taken from 2013) (4) . Another advance in conjunction with Trauma Centres and Networks (and certainly a contributor to their success) is the Intraosseous needle, a way of drilling into the bone marrow and injecting a drug as opposed to the normal Intravenous needles. This idea was first put into practice in the 1920's but quickly fell out of practice mainly due to technological difficulties and the large advances in intravenous technology at the time. Recently, however, the technique has been redeveloped by the Royal Army Medical Corps for use during the emergency evacuation of injured personnel where cannulation can be difficult (5) . Cannulation is the input of a needle into a person's veins to administer blood or resuscitory fluids. Due to the unsteady nature of high speed evacuation vehicles such as Chinook helicopters and Armoured Personnel Carriers along with the low blood pressure of certain casualties cannulation can be understandably difficult in this situation. Despite being developed for an entirely military purpose the Intraosseous Drill has also seen use in civilian hospitals (5,6) . Due to the bone marrow's large Blood supply any drug or substance given intravenously can be given intraosseously as well (6) . In situations where cannulation is difficult and/or time consuming, due to a lack of blood pressure (making the veins both harder to see and less likely to be pierced by the needle itself), a drug or resuscitation fluid can be administered Intraosseously with the same effect. The technology has seen much success in Great Ormond Street Hospital for treating children whose blood vessels tend to constrict and make venous access difficult when they go into shock (6) . Another major advance developed on the front lines of modern combat now making its way into the NHS is the usage of whole blood transfusions in Damage Control Resuscitation (DCR)** for coping with Massive Trauma. This technique was developed by US and British forces in Iraq to treat soldiers who had received Massive Trauma (7) . In civilian life, as said before, Massive Trauma is exceptionally rare and patients who receive massive transfusions (i.e. those who, in a military setting, would receive DCR) account for just 2-3% of all civilian trauma admissions however in the United States, where DCR was first trialled in the civilian setting and where these statistics were taken from, leading Trauma centres yield mortality rates of 40-70% for these patients (7) . This makes trauma requiring massive transfusion the injury with the highest proportion of preventable deaths in American civilian medicine (7) . To address this, DCR has recently been adopted by the majority of civilian hospitals in America and the UK. The technique involves a 1:1:1 ratio of Fresh Frozen Plasma (FFP), Red Blood Cells (RBC) and Platelets. Normally these ratios are different and the make-up of the mixture given is tailored to what the doctor believes the patient needs. This is called Component-based transfusion and usually results in FFP and RBC being given in lower ratios. The DCR technique was first presented in a paper by American Dr Borgman and his team after they observed the cases of 252 military survivors of massive trauma in 2007 (7) . The US Army then made it standard doctrine to use DCR with a high ratio
* .DCR actually refers to a system of dealing with Haemorrhagic shock first developed by the US army in the Iraq War but for the purpose of this essay we will be look at the whole blood transfusion aspect as this is the main component
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