Here's exactly why Military Combat Medicine is taking the lead in trauma care. When you're dealing with an extended evac time, the normal rules just don't apply... and you have to seriously begin to worry about perfusion to end-organs while not popping the clot. The Trauma Docs are learning TONS about this and training the field medics and corpsmen what has been learned. I just hope that some of what has been learned can be readily translated back into the civilian world for better trauma care.3x may be a stretch, but don't quote me...i think it's more along 1.5-2x. Still a fairly large amount in the long run.... In combat, when you have a guy who's lost 3 liters, do you really have enough crystalloids to replace that? or even give him a reasonable chance or survival? Which takes us back to the length of time for some MEDEVACS to arrive...1 hour might not be the time you're getting, it may be a lengthy time. I suppose this may be more of a situation dependent type of choice. If they're your guys, you should already be making sure they are well-hydrated warriors. All good points that are brought up though. I just don't think any medic is carrying around 9 bags of NS or LR to replace large quantities of fluid over long periods of time. I tend to roll with 1L LR, 1.5L NS, and 1L Hetastarch... sometimes with some Dex, depending on how I feel about things, all by personal choice, with my operators each carrying their own 500mL Hetastarch. Keep the faith though guys...I like hearing people discuss things like this...we're only making military medicine better.