Damage Control Resuscitation and the Walking Blood Bank

Damage control resuscitation (DCR) has evolved during the conflicts in Iraq and Afghanistan and involves rapid triage, hemorrhage, and sepsis control, as well as targeted blood product resuscitation for severely injured trauma patients. These principles have been effectively applied with special operations teams as well as land-based Role 2 and Role 3 medical units with up to 94% survival of combat-wounded despite an increase in injury severity scores. As the United States (U.S.) Navy evolves a distributed maritime operation (DMO) strategy with accompanying resuscitative teams, surgical teams will require comprehensive knowledge of the medical assets and limitations on individual platforms. This chapter prepares the surgical team for the challenges of DCR at sea. Effective prolonged care of critically injured patients in this setting will require the management of limited resources with significant constraints in equipment, training, personnel, and supply chains. Early utilization of a shipboard walking blood bank (WBB) can mitigate some of these limitations, and early implementation and pre-deployment screening of the ship’s embarked forces will optimize available blood donors.