Remote Damage Control Resuscitation

Purpose: Damage control resuscitation (DCR) is the accepted standard of care in military trauma care and is becoming an emerging practice in the civilian medical community. The presence of uncontrolled major hemorrhage, coupled with a delay in access to hemostatic surgical intervention, remains a primary contributor to preventable death in both combat and many domestic settings including rural areas and disaster sites. Therefore, the purpose of this translational policy research project was to adopt the US military’s Remote Damage Control Resuscitation protocols to civilian austere medical care. Methods: Civilian and military emergency care leaders throughout the world have sought a means to project DCR principles. The protocols have been taught at the US Army Center for Predeployment Medicine, Fort Sam Houston, TX, as well as by the Norwegian Naval Special Operations for several years, and were advocated for applicability in a civilian austere medical setting with minor modifications to accommodate their civilian counterparts. To spearhead the project, the Hemostatis and Oxygenation Research Network and the Remote Trauma Outcomes Research Network working groups reflected on military experiences from past conflicts, defined current capability gaps, and examined available and potential solutions for use domestic and abroad. Results: Although some military protocols needed to be adapted for the civilian application of Remote Damage Control Resuscitation, the principles of medical care in the military austere environment are similar to those in the civilian rural and maritime medical care settings. This work resulted in the proposed strategy “Remote Damage Control Resuscitation” to be used in civilian medical settings. The remote damage control resuscitation principles reinforce the importance of identifying and managing uncontrolled massive hemorrhage as part of a comprehensive approach to prehospital stabilization and enroute care. Conclusion: Continued efforts on behalf of The Hemostatis and Oxygenation Research Network and the Remote Trauma Outcomes Research Network will be paramount in the success and establishment of future RDCR programs both domestic and abroad.