Genetic Determinants of the Response to Acute Massive Blood Loss as a Factor in Planning Evacuation Measures in Field Conditions

Introduction. Acute massive blood loss and hemorrhagic shock remain major challenges for modern military medicine, accounting for over 90% of preventable battlefield deaths. Traditional methods of monitoring vital signs often prove ineffective in compensated conditions, when blood pressure and heart rate remain stable until sudden decompensation and the loss of more than 40% of circulating blood volume (CBV). Aim. This study aimed to systematize data on genetic markers that determine individual tolerance to hypovolemia and to justify their integration into digital predictive monitoring systems to optimize evacuation logistics. Methods. The study methodology included a comprehensive analysis of scientific publications from the PubMed, Scopus, and Google Scholar databases published between 2020 and 2026, as well as a review of current Tactical Combat Casualty Care (TCCC) clinical guidelines. Results. The analysis revealed that the population of soldiers is heterogeneous in terms of compensatory capacity, with groups demonstrating high tolerance (HT) and low tolerance (LT) identified. The genetic determinants of this distribution include polymorphisms in genes of the renin-angiotensin-aldosterone system (RAAS), specifically variations in angiotensin-converting enzyme (ACE) and angiotensin II receptor type 1 (AGTR1). Conclusions. The limitations of using genetic data in field conditions are discussed, and it is argued that the integration of molecular markers into tactical medicine is possible only after large-scale clinical validation and currently represents a promising theoretical direction for the development of long-term care protocols.