An upshot of war - damage control resuscitation

Management of battlefield casualties in Iraq and Afghanistan has seen considerable development in damage control resuscitation, which aims to address the risk of haemorrhage, initially due to mechanical damage; and thereafter due to the development of life-threatening coagulopathy. Damage control resuscitation combines a variety of techniques, such as the use of the combat application tourniquet and novel haemostatics, through to ground-breaking developments in transfusion protocols. These practical aspects of the doctrine are combined with an ethos which sees consultant-led care implemented from as close to the point of wounding as is possible. Meticulous trauma audit is included in this process and has allowed for rapid translation of knowledge into practice. The main elements of this doctrine are described.