Damage control resuscitation

Treatment of active hemorrhage, hemorrhagic shock, and prevention of re-bleeding is the name of your game in combat trauma. There are two big killers on the battlefield: severe brain injury and hemorrhage. You can't do a lot about the former, but through preparation and attention to detail, you can significantly impact the latter. Assume every injured patient you receive has active bleeding until proven otherwise and make sure that is how they are treated from the moment injury occurs. Be familiar with all the tools at your disposal to guide resuscitation and stop the bleeding. Look at your watch when the patient arrives and keep that ticking clock in mind during your initial trauma evaluation and resuscitation. The whole philosophy of damage control resuscitation (DCR) can be summarized by the observation that "Patients bleed warm whole blood, not just red cells. Therefore, we should replace this with warm whole blood or the equivalent, not cold and coagulopathic packed red blood cells, starting from minute one of the resuscitation.".