How to Prevent Deaths During War
By David Coultas, MD and Yulia Brockdorf, RD, LPC, FAWM
September 5, 2025
Wars bring countless tragedies, but if injuries are treated in a timely manner with rapid, simple, pre-hospital interventions, battlefield deaths are not inevitable. Two of the most common life-threatening wounds in war zones are severe hemorrhage (bleeding) from the arms and legs and penetrating chest injuries that result in lung collapse. Both can kill within minutes if left untreated, yet both have effective first-line treatments.
Stopping Life-Threatening Limb Bleeding
Gunfire and shrapnel often injure the arms and legs, where large blood vessels are especially vulnerable. When these vessels are damaged, uncontrolled bleeding can quickly become fatal.
A tourniquet is essential in a combat environment to immediately stop blood loss. It is fast to apply, can often be self-applied, is highly effective, and is often the only intervention that can keep a person alive long enough to reach the next level of care. In the chaos of battle, no other tool matches its ability to rapidly control life-threatening hemorrhage. Examples of quality tourniquets: CAT-7, SAM, SOFT, and Sich.
Tourniquets save lives, but they carry serious risks if left on too long. Prolonged application can lead to loss of the limb due to muscle and tissue death. Toxins from oxygen-deprived tissue build up in the limb; releasing them suddenly into the bloodstream can strain the kidneys and heart, creating potentially fatal complications.
Because of these risks, proper training emphasizes the timing of tourniquet application and, if the situation permits, tourniquet conversion. Conversion requires having the right supplies available: hemostatic agents and pressure dressings, which allow bleeding to be managed while preserving tissue perfusion (circulation) to the limb.
Examples of hemostatic dressings include:
- Combat Gauze – a kaolin-based gauze widely used in military medicine.
- Celox Gauze – a chitosan-based gauze that promotes rapid clot formation.
- ChitoGauze – another chitosan-based option with strong clotting action.
- XSTAT – a syringe-like applicator that injects tiny expanding sponges into the wound to rapidly block severe bleeding.
Examples of pressure dressings include:
- Emergency Trauma Dressing (ETD)
- Israeli Bandage
When tourniquets are applied with attention to timing and supported by these supplies, survival improves while reducing risks of a long-term disability.
Treating Penetrating Chest Wounds
Another frequent killer on the battlefield is the collapsed lung, caused by a penetrating chest wound from a bullet or piece of shrapnel. As the person breathes in, air enters the chest cavity through the wound rather than the lungs. With each breath, trapped air builds pressure in the chest, squeezing the lung further, and eventually compressing the heart. This progression is called a tension pneumothorax and is rapidly fatal if untreated.
The immediate prehospital treatment is a vented chest seal, which prevents additional air from entering the chest while allowing trapped air to escape. Examples of a self-adhesive vented chest seals include:
- HyFin Occlusive Dressing
- Halo Bolin Chest Seal
- SAM Chest Seal
- Asherman Chest Seal
Even in high-stress combat situations, use of properly applied quality chest seals can stabilize the injured person and buy critical time until evacuation or further medical care is possible.
DAWN Critical Frontline Supply Checklist
To maximize survival from life-threatening battlefield injuries, the following supplies are essential musts:
- Tourniquet – CAT-7, SAM, SOFT, Sich
- Hemostatic dressings – Combat Gauze, Celox Gauze, ChitoGauze, XSTAT.
- Pressure dressings – Emergency Trauma Dressing (ETD), Israeli Bandage.
- Chest seals – HyFin Halo Bolin, HyFin and SAM, Occlusive Vented Dressing, and Asherman Chest Seal.
Thank you to John Rudoff for the photos in this article – used with permission.