The Defence and Security Accelerator (DASA) is running a Market Exploration to explore the environment around Non-Compressible Haemorrhage (NCH). More specifically, understand who is doing work in this area to uncover the possible novel solutions of treating Non-Compressible Haemorrhage at a combat casualty scene.

1. Summary

On behalf of the Research and Clinical Innovation, Surgeon General’s Department, DASA is running a Market Exploration to identify existing technologies from Technology Readiness Level (TRL) 3 and above.

This will allow a better understanding of the current market capability to inform future medical research, treatment and development.

Whilst potentially successful technologies and concepts may be exploited, please note that this request for information is not a commitment to subsequently launch a formal DASA competition.

2. Background

Non-Compressible Haemorrhage refers to bleeding from anatomical structures that cannot be controlled, or only partially controlled, with application of external pressure, undertaken through an overlying tourniquet or direct manual pressure. Such bleeding is the chief cause of otherwise preventable battlefield death. NCH is highly lethal with a mortality rate of 85.5%

Life-threatening NCH typically requires surgery to arrest bleeding. From point of injury through to surgical care, treatments such as intravenous cannulation and administration of blood or blood substitutes can help mitigate shock and reduced tissue perfusion but cannot typically arrest bleeding.

The proper use of tourniquets and enhanced haemostatic dressings has reduced preventable death from compressible (limb) haemorrhage, but new devices and techniques to improve NCH are few and have yet to be taken up within military or civilian health systems at scale.

The current generation of devices include Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA), which relies upon technically adroit cannulation of the femoral artery and careful guidance of a catheter-mounted balloon to a segment of the aorta, prior to inflation and occlusion, or partial occlusion, to down-regulate perfusion of the abdomen and/or lower limbs.

Variants of tourniquets exist which serve to apply pressure to the vascular structures of the junctional areas (axilla, groin) or the aorta. This is easier to apply and takes substantially less skill than REBOA.

Both techniques produce collateral effects as perfusion is reduced to non-injured tissues as well as injured structures, with considerable physiological stresses and potential for life-threatening complications and need for mitigation.

A next generation therapy is direct injection of expanding foam into the abdominal cavity, via a percutaneously sited large calibre access device/trochar. The foam provides a tamponading (pressure) effect on bleeding structures. Animal evidence exists for efficacy; human trials are awaited in civilian trauma populations.

3. What we want

The Research and Clinical Innovation, Surgeon General’s Department is seeking options of treating NCH at the emergency scene that can be used by non-medical professionals in austere settings close to point of injury.

In particular, the exploration should focus on current generation after next medical device technologies that can target or triage the source of haemorrhage in the pre-hospital environment, from bodily cavity through to exact organ or vessel. Refinements of current medical devices, transfusion of blood or other infusion fluids, and pharmacologic means of haemostasis or haemorrhage control will be out-of-scope for this exploration. 

The medical device technology would need to facilitate selective targeting of the bleeding organ, structure or tissue, in order to permit precision haemorrhage control as far as possible. The proposed solution should limit negative sequalae such as inordinate compression on non-bleeding, healthy organs or tissue beds, metabolic disturbance due to ischaemia, or other collateral damage, through preservation of blood flow to non-injured organs as far as is possible.

Ideally, the proposed solution should be portable, simple to use and go well beyond the current limits of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA), Abdominal Tourniquet, or expanding foam. For instance, it could be applicable to haemorrhage within the thoracic cavity or the retroperitoneal areas of the abdomen. However, it should not compromise other aspects of care and follow-on surgery or require excessive resource to control, apply or remove.

4. What we don’t want

Technology that relies heavily on components sourced from China is non-desirable.

We are not interested in literature reviews, paper-based studies, consultancy, non-technical solutions or marginal improvements to existing capabilities. Technologies at TRL 2 or below are also not desirable.

This is not a competition and therefore we are not asking for costed proposals at this stage. This is a market engagement request for information exercise, and we do not commit to subsequently launching a formal DASA competition.

5. How to submit a Market Exploration Submission to DASA

Responses to this Market Exploration must be submitted via the DASA submission service, for which you will need to register. We recommend you use a Google Chrome browser to access the DASA submission service.

You will be asked for a title and short summary of your innovation, along with questions related to your organisation, your idea and technology maturity. We are seeking to understand what and how much further development is required for a complete solution to meet requirements, or whether a combination of separate solutions is required. The information you provide will assist in developing a statement of requirements for potential future activities.

Submissions must be submitted by Midday 12:00 (BST) on 15 April 2025. Unfortunately, we are unable to accept any submissions after this point.

Please only provide details of one product/capability per submission. If you have a number of potential solutions, then please submit multiple forms.

If you have any questions, please email accelerator@dstl.gov.uk with “Market Exploration: Non-Compressible Haemorrhage – Novel Technologies” in the subject line.

6. How we use your information

Information you provide to us in a Market Exploration Submission, that is not already available to us from other sources, will be handled in-confidence. By submitting a Market Exploration Submission you are giving us permission to keep and use the information for our internal purposes, and to provide the information onwards, in-confidence, within UK Government. The Defence and Security Accelerator will not use or disclose the information for any other purpose, without first requesting permission to do so.