What's the difference between the lethal diamond and the lethal triad? Traditionally, we've been taught that the lethal triad is hypothermia, acidosis, which then ultimately leads to a coagulopathy, which increases bleeding and leads to casualty death.

So we basically took that triangle and we said calcium is a very important part of that process. What studies have shown is that casualties wind up hypocalcemic early on in hemorrhagic shock. This can further be compounded by the administration of blood products, where they have high levels of CPD (Citrate Phosphate Dextrose), which binds calcium and can further make your casualty hypocalcemic. So now you've got three factors all leading to coagulopathy. So you've got hypocalcemia, got acidosis, and then you've got hypothermia as well.

Focus your interventions early on in treating those. We're going to use whole blood. We're going to get our casualty warm. jury's still out on how much calcium to give and when to give it. But we need to be thinking about that early on in hemorrhagic shock, especially if we're administering blood products.