Prehospital Blood Product Use in Civilian and Military Settings:
A Systematic Evidence Review of Lyophilized Plasma, Red Blood Cell Concentrates, Whole Blood, and Fibrinogen

Christoph Jänig^a, Björn Hossfeld^b

^a Department of Anesthesiology and Intensive Care Medicine, Bundeswehr Central Hospital Koblenz

^b Department of Anesthesiology, Intensive Care, Emergency Medicine, and Pain Medicine, Bundeswehr Hospital Ulm

Summary

Traumatic hemorrhage remains a leading preventable cause of death in both civilian and military trauma cases. Damage control resuscitation (DCR) aims to provide early hemostatic support and to minimize crystalloid volume therapy. The prehospital use of plasma, red blood cell concentrates, fibrinogen, and whole blood is controversial on an international level.

A structured narrative review of randomized controlled trials, multicenter registry analyses, and systematic reviews was conducted, focusing on mortality, transfusion needs, and safety. The evidence was compared across European, U.S., and military settings.

European randomized trials show no significant mortality benefit for prehospital blood product administration, likely due to short transport times. In U.S. air medical systems with longer prehospital phases, there are indications of decreased 30-day mortality. Military registry data consistently indicate the benefits of early balanced transfusion strategies and whole blood in cases of prolonged evacuations. The advantage heavily depends on the time to definitive hemorrhage control.

Prehospital blood product administration is safe and feasible, but its clinical benefit depends on the context. In military situations with extended evacuation times, early implementation of DCR is strategically important.

Keywords: prehospital transfusion; damage control resuscitation; traumatic hemorrhage; whole blood; military medicine

Introduction

This article aims to clarify the current evidence surrounding the prehospital use of various blood products. Traumatic hemorrhage remains a leading preventable cause of death after severe injuries worldwide, in both civilian and military settings [7]. While definitive surgical hemostasis is the primary treatment, early physiological stabilization is crucial for survival during the prehospital phase. The development of trauma-induced coagulopathy (TIC) in the first minutes after injury is highly predictive of outcomes and linked to significantly higher mortality [16][26].

The concept of damage control resuscitation (DCR) originated from military experiences in Iraq and Afghanistan. Data from the Department of Defense Trauma Registry (DoDTR)¹

Joint Theater Trauma Registry (JTTR) showed that early, balanced transfusion of plasma and red blood cells in a 1:1 ratio improved survival rates [18][25][27]. At the same time, it became clear that excessive crystalloid fluid therapy could worsen coagulopathy and outcomes [14]. Therefore, DCR takes an integrated approach of permissive hypotension, early support for coagulopathy, and minimizing crystalloid use.

 

While these strategies are now standard in hospitals and included in international guidelines [8], the role of administering blood products before reaching the hospital remains a topic of ongoing debate. Based on these considerations, rescue helicopters stationed at Bundeswehr hospitals in Hamburg, Koblenz, and Ulm have been carrying blood products, such as red blood cell concentrates, plasma, and coagulation factors, for several years to treat severely injured patients in civilian rescue services (Figures 1 and 2).

The main question is whether early administration of plasma, red blood cell concentrates, fibrinogen, or whole blood before reaching the trauma center provides a standalone prognostic benefit – or if the primary effect is due to rapid surgical control of bleeding.

Randomized controlled trials from Europe, such as RePHILL and PREHO-PLYO, did not show a significant mortality benefit from prehospital plasma administration [3][19]. In contrast, the U.S. PAMPer study demonstrated a notable reduction in 30-day mortality, especially with longer transport times [12]. However, PAMPer mainly involves secondary transfers of patients initially treated peripherally to trauma centers by helicopter; patients with traumatic brain injury particularly benefited, indicating that plasma administration may have contributed more to circulatory stabilization than to improving coagulation. Military registry analyses consistently report improved survival rates with early “balanced transfusion” and the use of whole blood [28].

These contrasting results raise essential questions about how the effect depends on context. European trauma care systems feature short transport times and a high density of specialized trauma centers. Meanwhile, military scenarios often involve longer evacuation times, limited resources, and a high rate of penetrating injuries [10]. Under these conditions, implementing DCR principles in the prehospital setting could become much more critical.

Furthermore, the increasing security importance of traditional land and alliance defense scenarios, where limited air superiority and delayed evacuation are expected, is emphasized. The concept of “Prolonged Casualty Care” is therefore regaining attention in military medical planning. In these scenarios, the best prehospital blood product strategy poses not only a clinical challenge but also a strategic one.

Therefore, this review aims to:

1. Systematically present the current evidence on prehospital administration of plasma, red blood cell concentrates, fibrinogen, and whole blood,
2. critically analyze the differences between European, U.S., and military settings,
3. contextualize the results within Damage Control Resuscitation, and
4. extract military medical implications for future scenarios.

The central hypothesis is that the prognostic effect of prehospital blood product administration is significantly influenced by the time to definitive hemostasis – and therefore system- and scenario-dependent.

Materials and Methods

This work is a structured narrative review with a system-comparative analysis of evidence on prehospital blood product administration in civilian European, U.S., and military settings. The aim was to evaluate randomized controlled trials (RCTs), prospective cohort studies, registry analyses, and systematic reviews regarding clinical endpoints (mortality, transfusion requirements, coagulation parameters, side effects) and to place them in the context of damage control resuscitation (DCR). A formal systematic review with meta-analysis was not conducted; however, the work follows the methodological principles of a structured literature review and transparent evidence presentation.

Literature Search

The literature search was carried out from January to February 2026 in the databases PubMed/MEDLINE, Embase, and Cochrane Library. Reference lists of relevant guidelines and reviews were also manually searched.

The search strategy combined the following keywords and MeSH terms:

• “prehospital blood transfusion”,
• “damage control resuscitation”,
• “freeze-dried plasma” / “lyophilized plasma”,
• “whole blood transfusion”,
• “fibrinogen concentrate”,
• “military trauma”,
• “combat casualty care”, and
• “hemorrhagic shock”.

The search was limited to publications in English and German. No specific time limit was set, but the focus was on publications from 2005 onward, as modern DCR strategies have been systematically implemented since then.

System Comparison

For comparing Germany/Europe, the U.S. (civilian), and military environments, the following systemic parameters were considered:

• median prehospital transport time,
• mechanism of injury (blunt vs. penetrating),
• availability of surgical resources,
• implementation level of DCR principles.

The analysis was hypothesis-driven, assuming that time to definitive hemostasis is a key factor influencing the effect of prehospital blood products.

Military Medical Context

For evaluating military evidence, additional data from the DoDTR, Tactical Combat Casualty Care (TCCC) publications, and military whole blood programs were considered. The focus was especially on operational conditions, particularly on prolonged casualty/field care, evacuation delays, and infrastructural/resource limitations.

Results

Overview of Included Evidence

The structured analysis involved randomized controlled trials (RCTs), prospective cohort studies, multicenter registry analyses, and systematic reviews. The evidence is unevenly distributed among the three care settings examined:

• Europe (especially the UK, France, Germany): several RCTs on prehospital plasma administration [3][19], a pilot randomized study on fibrinogen [23], and additional registry and observational data [11].
• U.S. (civilian): two larger RCTs (PAMPer, COMBAT) [12][13] and secondary analyses [20][31].
• Military setting: registry analyses from Afghanistan and Iraq, cohort studies on balanced transfusion and whole blood [11][18][28].

The main endpoints of the included studies were mostly 24-hour and 30-day mortality. Secondary endpoints included transfusion needs, coagulation parameters, and transfusion-related complications.

Results in the European Setting

Plasma

The RePHILL study randomized patients with traumatic hemorrhagic shock to prehospital administration of red blood cell concentrates and lyophilized plasma versus standard therapy with crystalloid infusion [3]. No significant difference was found in the primary combined endpoint of 30-day mortality and lactate clearance. Additionally, there was no significant advantage in isolated mortality. The PREHO-PLYO study examined prehospital administration of lyophilized plasma compared to standard therapy [19]. It showed an improvement in some coagulation parameters upon hospital admission but no significant reduction in mortality. Systematic reviews and meta-analyses that included these studies confirmed the absence of a consistent mortality benefit in the European setting [6].

Red Blood Cell Concentrates

Observational studies and registry data from Germany and France show that prehospital administration of red blood cell concentrates (EK) is technically feasible and safe [1]. However, a clear reduction in 30-day mortality has not been consistently demonstrated.

Fibrinogen

The FIinTIC study examined the prehospital use of fibrinogen concentrate in patients with traumatic bleeding [23]. The study found a significant improvement in viscoelastic coagulation parameters (ROTEM), but no significant difference in clinical outcomes, such as mortality or transfusion requirements. Since it was a pilot study, it was not designed to detect differences in key endpoints.

Results in the U.S. Civilian Setting

PAMPer Study

The PAMPer study randomized trauma patients at risk of hemorrhagic shock during air transport to receive plasma or standard therapy [12]. The 30-day mortality was 23% in the plasma group compared to 33% in the control group. This represents a significant absolute risk reduction. Subgroup analyses revealed a particularly notable effect in:

• longer transport times,
• severe hypotension, and
• patients with concomitant traumatic brain injury [31].

COMBAT Study

The COMBAT study examined a similar question in urban ground-based emergency medical services with shorter transport times [13]. In this case, there was no significant difference in mortality between the intervention and control groups.

Secondary analyses of PAMPer data revealed a decrease in endothelial activation markers and signs of better early hemostasis [20]. Registry data from U.S. trauma centers indicate that the use of plasma and EK in severe bleeding may be linked to improved early outcomes [27].

Results in the Military Setting

Balanced Transfusion

Analysis of the DoDTR revealed a significant association between early balanced transfusion (plasma:EK ratio near 1:1) and improved survival in severely injured soldiers [18][25].

Whole Blood

Several military cohort studies show significantly reduced 24-hour and 30-day mortality with the use of whole blood compared to component strategies [11][22][28]. Whole blood was especially linked to better survival rates in patients experiencing massive bleeding and penetrating injuries.

Safety Profile

Military data show no significantly increased risk of transfusion-related complications with early administration of plasma or whole blood [11][28].

Comparison of Transport Times and Injury Patterns

In European RCTs, median prehospital transport time is typically under 25 minutes [3][19]. In the PAMPer study, it often exceeded 30 minutes [12]. Military evacuation times frequently surpass 60 minutes [10][25]. Regarding injury patterns, blunt trauma is predominant in European civilian emergency services, whereas military injuries are often penetrating or related to explosions [10][25].

Safety and Side Effects

Neither European nor U.S. RCTs reported a significant increase in serious transfusion-related adverse events (e.g., TRALI, thromboembolic events) [6]. Military data also confirm an acceptable safety profile for early administration of blood products [11][28].

Comparison of Civil European, U.S., and Military Evidence for Prehospital Blood Product Administration

The scientific evidence for prehospital blood product transfusion reveals clear differences between European, U.S., and military care settings. While European randomized studies did not consistently show a mortality benefit, U.S. data under specific conditions indicated a significant survival advantage. Military registry analyses also demonstrated consistent positive effects of earlier balanced transfusion strategies.

The PAMPer study [25] showed an approximately 10% absolute reduction in 30-day mortality through prehospital plasma administration during air transport in a cluster-randomized design. Secondary analyses indicated that this benefit was especially notable with transport times longer than 20 minutes and in cases of severe hemorrhagic shock. Conversely, the COMBAT study [21], which involved shorter transport times, did not reveal a significant survival benefit, suggesting a time-dependent effect.

In Europe, neither RePHILL [3] nor PREHO-PLYO [19] demonstrated a reduction in mortality. These studies are characterized by shorter prehospital care times and a high rate of blunt trauma. In highly developed trauma centers with rapid surgical hemostasis, the additional benefit of prehospital plasma administration appears limited.

Military data from Afghanistan and Iraq [25] consistently show improved survival rates with early balanced transfusion strategies, especially when using whole blood. These results should be viewed in the context of longer evacuation times, a high incidence of penetrating injuries, and significant blood loss. Early coagulation support becomes critically important under these conditions.

Discussion

Interpretation of Results in the International Context

The current data show a consistent but context-dependent pattern: While in European civilian emergency services, despite methodologically high-quality randomized studies, no significant mortality benefit from prehospital blood product administration is detectable [3][19], the U.S. PAMPer study demonstrates a significant reduction in 30-day mortality under certain conditions [12]. Military registry analyses repeatedly report improved survival rates through early balanced transfusion and the use of whole blood [18][28]. This divergence is less a contradiction than a reflection of structural differences in care.

Transport Time as a Key Factor

A central finding of the comparative analysis is the significance of prehospital time to achieve definitive hemostasis. In European studies, the median transport time was generally under 25 minutes [3][19]. However, in the PAMPer study, it was often over 30 minutes [12]. It should be noted that PAMPer only considers the helicopter transport time, not the total time from injury, as patients might have experienced longer care times before air transport was initiated. Military evacuation times frequently reach 60 minutes or more [10][25].

Pathophysiologically, it is believed that trauma-induced coagulopathy (TIC) progresses during the early shock phase and worsens with longer periods of hypoperfusion [15][26]. Plasma provides not only its coagulation role but also endothelial protective effects [15][24]. These mechanisms become increasingly important as the duration of untreated shock lengthens.

The findings from PAMPer and COMBAT support this hypothesis indirectly: while a mortality benefit was observed with longer transport times [12], there was no significant effect seen with shorter urban transport times [13].

Injury Patterns and Pathophysiology

In addition to transport time, the injury patterns in investigations show significant differences. European trauma centers are mostly faced with blunt trauma. In contrast, military injuries are often penetrating or related to explosions [10][25].

Penetrating injuries more frequently cause sudden massive blood loss and vascular damage. Subgroup analyses of civilian-military data suggest that these patients might benefit more from early plasma therapy [20]. The higher rate of massive bleeding in military cases could partly explain the stronger observed effect.

Balanced Transfusion versus Whole Blood

Military evidence consistently shows positive links between early balanced transfusion (plasma:EK ratio approximately 1:1) and survival [18][25]. Simultaneously, whole blood is increasingly gaining importance [4][21][28].

Whole blood offers several theoretical benefits:

• natural ratio of blood components,
• simpler logistics,
• less exposure to multiple donors, and
• lower administrative complexity during deployment.

Registry data suggest a decrease in early mortality with the use of whole blood [11][28]. However, these findings are mainly based on observational data, so confounding effects cannot be fully excluded. Randomized military studies are currently missing. Nevertheless, whole blood seems strategically sound in situations with prolonged evacuation and limited resources.

Fibrinogen – Biological Plausibility versus Clinical Evidence

Fibrinogen is often the earliest limiting coagulation factor in severe bleeding [9]. The FIinTIC study showed an improvement in viscoelastic parameters [23], but could not demonstrate a mortality benefit. Newer meta-analyses also confirm the lack of robust clinical endpoint effects [17][22]. Possible reasons include:

• small sample sizes,
• heterogeneous patient selection, and
• combination with other transfusion strategies.

In military settings with a high incidence of massive blood loss, targeted substitution could still play a role, particularly alongside point-of-care diagnostics.

Safety of Prehospital Blood Product Administration

A key finding from the current evidence is the consistently positive safety profile. Neither European nor U.S. RCTs showed a notable increase in serious transfusion-related complications [6]. Military registry data also support an acceptable risk profile [11][28]. This finding is especially important for military operational scenarios, where risk-benefit assessments must be made under tactical conditions.

Transferability to Future Scenarios

Considering potential scenarios of conventional land and alliance defense, changing conditions are anticipated:

• limited air superiority,
• delayed evacuation times along the rescue chain, and
• overloaded surgical capacities.

Therefore, the concept of prolonged casualty care becomes increasingly important. Under these circumstances, prehospital DCR strategies grow more relevant. Existing evidence suggests that, especially with extended care, early blood component or whole blood transfusion could have prognostic significance.

Limitations of the Evidence

The analysis faces several limitations:

• heterogeneity among study populations,
• varying and potentially unfavorable endpoint definitions,
• lack of randomized military studies, and
• possible selection and survivorship bias in registry analyses.

Trauma care includes numerous measures and treatment steps, from prehospital rescue to shock room care, often involving multiple surgeries and multi-day intensive therapy. Judging the impact of administering two units of red blood cell concentrates or plasma at the start of care on patient outcomes is like assessing the success of a Himalayan expedition based solely on whether climbers drink tea or coffee at base camp. Additionally, it is important to note that most studies were conducted within well-developed healthcare systems. The applicability of these findings to extended military conflict scenarios with large numbers of casualties remains uncertain.

In summary, the evidence indicates that the benefit of prehospital blood products is mostly influenced by system factors. Specifically, the time to achieve definitive hemostasis plays a key role in this effect. For military situations with potentially longer care durations, early adoption of DCR principles in the prehospital setting appears especially important.

Conclusion

The current data oppose a universal, system-independent recommendation for prehospital blood product use. Instead, a context-specific effect is clear, significantly influenced by

• transport time,
• injury pattern,
• infrastructure, and
• available operative resources.

In urban European settings with short transport times, the additional mortality benefit appears limited. However, in military settings with extended evacuation times, early damage control resuscitation (DCR) principles become strategically important.

Key messages

• The benefit of prehospital blood products is highly dependent on the context and increases with longer transport times to definitive hemostasis.
• In civilian European emergency services with brief transport durations, a clear mortality advantage has not yet been established; selective indications are necessary.
• In military scenarios with prolonged evacuation, early damage control resuscitation strategies are highly relevant operationally.
• The prehospital use of low-titer O whole blood offers logistical advantages and may provide better hemostatic effectiveness.

References

1. Abuelazm M, Rezq H, Mahmoud A, et al. The efficacy and safety of pre-hospital plasma transfusion: systematic review and meta-analysis of randomized controlled trials. Eur J Trauma Emerg Surg. 2024;50(6):2697-2707. mehr lesen
2. Apelseth TO, Doyle B, Evans R, et al. Current transfusion practice and need for new blood products to ensure blood supply for patients with major hemorrhage in Europe. Transfusion. 2023;63(Suppl 3):S105–S111. mehr lesen
3. Brohi K, Cohen MJ, Davenport RA. Acute traumatic coagulopathy: mechanism, identification and effect. J Trauma. 2007;63(6):121–127. mehr lesen
4. Burt T, Guilliam A, Cole E, Davenport R. Effect of early administration of fibrinogen replacement therapy in traumatic haemorrhage: systematic review and meta-analysis of randomised controlled trials. Crit Care. 2025;29:49. mehr lesen
5. Cannon JW. Hemorrhagic shock. N Engl J Med. 2018;378(4):370–379. mehr lesen
6. Cap AP, Beckett A, Benov A, et al. Whole blood transfusion. Transfusion. 2018;58(Suppl 2):79S–88S. mehr lesen
7. Crombie N, Doughty HA, Bishop JRB, et al. Resuscitation with blood products in patients with trauma-related haemorrhagic shock receiving prehospital care (RePHILL): a multicentre, open-label, randomised controlled phase 3 trial. Lancet Haematol. 2022;9(4):e250–e261. mehr lesen
8. Curry N, Davis PW. What’s new in resuscitation strategies for trauma? Lancet Haematol. 2015;2(2):e75–e83. mehr lesen
9. Davenport R, Curry N, Fox EE, et al. Early and Empirical High-Dose Cryoprecipitate for Hemorrhage After Traumatic Injury: The CRYOSTAT-2 Randomized Clinical Trial. JAMA. 2023;330(19):1882–1891. mehr lesen
10. Duchesne JC, Hunt JP, Wahl G, et al. Review of current blood transfusion strategies in trauma. Ann Surg. 2008;247(3):417–424. mehr lesen
11. Gruen DS, Guyette FX, Brown JB, et al. Association of prehospital plasma transfusion with survival in patients with traumatic brain injury. JAMA Netw Open. 2020;3(11):e2020532. mehr lesen
12. Holcomb JB, del Junco DJ, Fox EE, et al. The prospective, observational, multicenter, major trauma transfusion (PROMMTT) study. J Trauma Acute Care Surg. 2013;75(Suppl 1):S3–S10. mehr lesen
13. Hossfeld B, Maegele M, Lier H. Pre-hospital blood products for the care of bleeding trauma patients. Dtsch Arztebl Int. 2023;120(40):670–676. mehr lesen
14. Jänig C, Willms C, Schwietring J, et al. Patients at risk for transfusion – a six-year multicentre analysis of more than 320,000 helicopter emergency medical service missions. J Clin Med. 2023;12(23):7310. mehr lesen
15. Johansson PI, Stensballe J, Ostrowski SR. Current management of massive hemorrhage in trauma. Scand J Trauma Resusc Emerg Med. 2012 Jul 9;20:47. mehr lesen
16. Jost D, Lemoine S, Lemoine F, et al. Prehospital lyophilized plasma transfusion for trauma-induced coagulopathy in patients at risk for hemorrhagic shock: a randomized clinical trial. JAMA Netw Open. 2022;5(7):e2223619. mehr lesen
17. Kravitz, M.S., Kattouf, N., Stewart, I.J. et al. Plasma for prevention and treatment of glycocalyx degradation in trauma and sepsis.Crit Care. 2024 Jul 20;28(1):254. mehr lesen
18. Levy MJ, Cap AP, Spinella PC. Whole blood in prehospital hemorrhagic shock: emerging evidence and future directions. Trauma Surg Acute Care Open. 2025;10:e001234. mehr lesen
19. Maegele M, Paffrath T, Bouillon B. Acute traumatic coagulopathy in severe injury: incidence, risk stratification, and treatment options. Dtsch Arztebl Int. 2011 Dec;108(49):827-835. mehr lesen
20. Moore HB, Moore EE, Chapman MP, et al. Plasma-first resuscitation to treat hemorrhagic shock during emergency ground transportation in an urban area: a randomized trial. JAMA. 2018;319(19):1955–1965. mehr lesen
21. Perkins JG, Cap AP, Spinella PC, et al. Comparison of component therapy and whole blood in combat casualties. J Trauma. 2009;66(4 Suppl):S69–S76. mehr lesen
22. Roberts I, Shakur H, Afolabi A, et al. Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients (CRASH-2). Lancet. 2010;376(9734):23–32. mehr lesen
23. Rossaint R, Bouillon B, Cerny V, et al. The European guideline on management of major bleeding and coagulopathy following trauma. Crit Care. 2010;14:R52. mehr lesen
24. Rourke C, Curry N, Khan S, et al. Fibrinogen levels during trauma hemorrhage. Br J Surg. 2012;99(Suppl 1):26–33. mehr lesen
25. Shackelford SA, Del Junco DJ, Powell-Dunford N, et al. Association of prehospital blood product transfusion during medical evacuation of combat casualties in Afghanistan with acute and 30-day survival. J Trauma Acute Care Surg. 2017;82(Suppl 1):S40–S51. mehr lesen
26. Sperry JL, Guyette FX, Brown JB, et al. Prehospital plasma during air medical transport in trauma patients at risk for hemorrhagic shock. N Engl J Med. 2018;379(4):315–326. mehr lesen
27. Spinella PC, Perkins JG, Grathwohl KW, Beekley AC, Holcomb JB. Warm fresh whole blood is independently associated with improved survival for patients with combat-related traumatic injuries. J Trauma. 2009 Apr;66(4 Suppl):S69-76. mehr lesen
28. Spinella PC, Perkins JG, Grathwohl KW, Beekley AC, Niles SE, McLaughlin DF, Wade CE, Holcomb JB. Effect of plasma and red blood cell transfusions on survival in patients with combat related traumatic injuries. J Trauma. 2008 Feb;64(2 Suppl):S69-s77; discussion S77-S78. . mehr lesen
29. Tucker H, Brohi K, Tan J, et al. Association of red blood cells and plasma transfusion versus red blood cell transfusion only with survival for treatment of major traumatic hemorrhage in prehospital setting in England: a multicenter study. Crit Care. 2023;27(1):25. mehr lesen
30. Yazer MH, Spinella PC. An international survey on the use of low titer group O whole blood for the resuscitation of civilian trauma patients in 2020. Transfusion. 2020 Jun;60 Suppl 3:S176-S179. mehr lesen
31. Ziegler B, Bachler M, Haberfellner H, et al. Efficacy of prehospital administration of fibrinogen concentrate in trauma patients bleeding or presumed to bleed (FIinTIC): a multicentre, double-blind, placebo-controlled randomised pilot study. Eur J Anaesthesiol. 2021;38(4):348–357. mehr lesen

Manuscript Data

Citation

Jänig C, Hossfeld B. Prehospital Blood Product Use in Civilian and Military Settings – Evidence, System Comparison, and Incorporation into Damage Control Resuscitation. WMM 2026;70(5E):8.

DOI: https://doi.org/10.48701/opus4-872

For the Authors

Commander (Navy MC) Dr. Christoph Jänig

Department of Anesthesiology and Intensive Care

Bundeswehr Central Hospital Koblenz

Rübenacher Str. 170, D-56072 Koblenz

E-Mail: christoph.jaenig@gmail.com

¹The Joint Theater Trauma Registry (JTTR), established in 2004, was transferred to the Department of Defense Trauma Registry (DoDTR) in 2011.

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