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Invited Critique
November 2000

Feasibility of Damage Control Surgery in the Management of Military Combat Casualties—Invited Critique

Arch Surg. 2000;135(11):1327. doi:10.1001/archsurg.135.11.1327

It is evident from the analysis by Eiseman et al that DCS provides a challenge and an opportunity for conventional planners on how to allocate resources when, predictably, clinical needs exceed available resources. Damage control surgery, although conceptually new, actually uses well-tested surgical approaches in a more abbreviated context. The operative emphasis is on stopping hemorrhage and controlling ongoing contamination; the physiologic emphasis is on restoring body temperature, normal coagulation, and acid-base balance. The challenge to the surgeon who first encounters the wounded patient is to defer from providing definitive repair. It is the initial surgeon's role to keep the context abbreviated. The challenge to the system is to quickly transport the critically injured casualty in a physiologically supportive environment to a secondary facility for critical care and definitive surgery.

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