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Annex D Prolonged Casualty Care (PCC) Practice Test

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The lethal diamond includes hypocalcemia as one of its components.
Correct Answer:
True
Explanation:
The lethal diamond expands the traditional lethal triad by adding hypocalcemia as a fourth critical factor. In severe bleeding and rapid resuscitation, citrate from stored blood can bind calcium, lowering ionized calcium levels. Calcium is essential for the coagulation cascade and for the heart’s ability to pump effectively; when calcium drops, clotting worsens and perfusion can deteriorate, creating a deadly cycle. So, stating that hypocalcemia is included in the lethal diamond is correct. Hypothermia and coagulopathy are also part of this framework, highlighting how these factors interact to drive worsening hemorrhagic shock.

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