Damage Control Resuscitation and Surgery in a Forward Combat Setting

Abstract

Surgical management of the severely injured trauma patient is a balance between managing abnormal physiology and performing definitive repair of injuries. When hemodynamic impairment is present immediate care consistent with Advance Trauma Life Support (ATLSTM) guidelines is required. However, associated vascular and/or visceral compromise carry significant morbidity and mortality that must be addressed. This equilibrium, now manifest in the principles of damage control resuscitation, is the standard approach in trauma surgery. In the setting of combat, a remote and resource-limited environment, several other concerns affect management decisions. Combat casualty care must take into consideration pre-hospital interventions, location, triage, supply, personnel, transportation, security, and operational conditions specific to theaters of conflict. Ultimately damage control is one of many forms of triage within the greater scope of trauma care.