I really wonder if injuries are that much different between the military and the civilian population.
I would think that what a medic or surgeon sees in combat is rather different from what even busy civilian trauma surgeons and EMS see on a regular basis. At a very high level, an explosion is an explosion and a penetrating wound is a penetrating but that's probably where the similarity ends. First, obviously, the causes of wounds are typically very different. The forces involved with high explosives, weapons versus just accidents, high velocity ammunition, jagged shrapnel versus a smooth blade or prison shank, how often multiple types of injuries occur together, they're all rather different. Then again, many military doctors do get experience at civilian hospitals like County-USC Med Center here in Southern California.
Also, don't forget that it's not just the wound itself that is different. On the battlefield, you are severely constrained as far as supplies and equipment goes, and there may be quite a long delay until definitive medical care can be reached. Actually, that's apparently the main impetus for the combat lifesaver training and the high premium put on developing effective hemostatics, both internal and external. On today's highly dispersed battlefield, the nearest combat medic could be quite far away and the combat lifesaver is supposed to help bridge that gap. And once the medic reaches you, it could still be quite a while until the patient receives definitive medical care, whether due to distance, transportation delays, or just surgical capacity. The Army's doctrine of continuous operations can put huge burdens on surgical resources as the wounded continue to keep flowing in and the most severely wounded continually get triaged to the head of the line.
That said, I've been thinking about this topic for the past week, considering the other comments, and also doing some more reading on the topic. I have softened in my reaction to the article, although I do maintain that these soldiers are still basically guinea pigs since the Army is basically seeing what works as they go, not necessarily having any prior clinical research to build on. For someone trained for civilian research and a strong believer in "evidence based medicine", it's hard not to instinctively cringe at what was in the news article, so my first post reflected that initial gut reaction.
I wouldn't consider this acceptable practice in civilian medicine or even military medicine in peacetime, however, I suppose that the great celestial balance between the Ethics/Patient Welfare and Potential Benefits shifts when these soldiers are already in harm's way--very grave harm. I never doubted that exciting advances could be made this way, but it's hard to instinctively avoid thinking of an "ends justifies the means" argument against such relatively fast and loose development and that is always a danger to look out for.
I agree with Glock-a-Roo that there's been a lot of new developments in combat trauma care very recently, some of which I had heard about but a lot of it totally new to me until I read about them recently. Pretty crazy stuff, actually, particularly for any EMS folks out there. I suspect that the 18D instructor that Glock-a-Roo spoke with could show an EMT or paramedic a lot of new stuff that would be really different. Not just different, but maybe even seem wrong. Like the comeback of frequent tourniquet use. Or low fluid volume resuscitation, including permitting hypotension.
I thought that was pretty wild when I first read about it this weekend. On the battlefield, the medic is limited in how much they can carry, so they don't have bags and bags of IV fluid with them. There is also the problem of delayed transport, so the problem of a clot coming lose and restarting bleeding is a major concern. Low volume resuscitation means less fluid is necessary, and permitting the patient's blood pressure to remain low will minimize the risk of the clot being popped off from a higher blood pressure or vigorous resuscitation. There is a logic to it, but it's quite different from anything that civilian folks are accustomed to since hypotension is generally something to be vigorously corrected. Particularly if a head injury is involved, even brief episodes of hypotension is associated with worse outcomes. Anyway, those are just two new things which go against the grain.
Some of these things may translate into civilian EMS and medicine, but like Pete's example of MAST, some don't. Or, like in the news article, Shock Trauma's research (one of the top civilian trauma centers) that showed no difference between using blood components and whole blood transfusions. But other developments, like hemostatic agents for external bleeding have apparently made the transition, and some things may become wildnerness medicine staples. Only time, and experience, will tell.