Feasibility of damage control surgery in the management of military combat casualties

Unique and expanded applications of staged operative management are undergoing careful evaluation in many civilian level 1 trauma centers under the rubric of damage control surgery. Recently there have been advocates for its broad application to the early management of critically injured combat casualties. However, the enormous logistic requirements for such strategics are contrary to the demands of the usual wartime scenario. On the basis of experience in civilian trauma centers and combat casualty management, we question the suggested extensive role of damage control surgery during wartime. Each decision point in damage control surgery should be analyzed as it is altered (sensitivity analysis) by conditions of war. It is unwise to adopt such indications unchanged from current civilian trauma policy.