Damage control surgery: Military

The term "damage control" is rooted in Navy history as the way to approach shipboard battle damage. Essentially, it applied to quick measures aimed at stopping flood waters from rushing in and sinking a ship. In surgery, the term has come to mean application of expedient approaches to stemming exsanguinating hemorrhage and controlling contamination, in the physiologically deranged patient, to the point where resuscitation can occur. Trauma surgery typically has four stages. First is hemorrhage control, second is contamination control, third is evaluation or diagnosis, and fourth is reconstruction. Damage control surgery mandates the first two stages but defers the third and fourth stages till a more appropriate time and place. In civilian damage control, it was originally developed as a temporizing measure that provides time for restoration of normal physiology and, later, normal anatomy. In this chapter, we look to apply damage control surgery methods to the combat trauma environment. In this setting, the logistics are often completely different than in civilian trauma centers and are often done not for physiology restoration but due to the logistics and resources of the combat environment.