The document discusses the principles and procedures of damage control surgery (DCS) in trauma care, highlighting its origins in abdominal trauma and its application in military and civilian contexts. It emphasizes the importance of rapid action to control bleeding and manage complex injuries, particularly under resource-limited conditions during disaster missions. The text also references various studies and statistics related to the factors influencing survival rates following traumatic injuries.

1. Dr. med. Philipp Fischer Klinik und Poliklinik für Orthopädie und Unfallchirurgie Universitätsklinikum Bonn Direktor: Prof. D. C. Wirtz Disaster-Management – damage control procedures

2. Development Damage Control Surgery Origin in Abdominaltraumatolgie Stone et. al 1983: Abdominell Packing with intraoperative Koagulopathie Rotondo et al 1993: „Damage Control “ abdominell Trauma civil Patients DSTC Course IATSIC

3. Phases of Damage Control 1 Decision 2 DCS Procedures 3 Restoration of physiology 5 Reconstruct. Surgery SR / OP OP ICU OR OP 4 Definitive Surgery OP

4. Damage Control – What is this ? Surface Ship Survivability Naval War Publication 3-20.31. Washington, DC: Departement of Defense; 1996

5. Damage Control warm up Coagulation Substitution Ventilation ..... Hypothermie Blood loss soft tissue trauma ..... Battlefield - OP D.doll The secure harbor - ICU

6. Damage control Surgery Principles Fast control of bleeding Contamination control No reconstructive surgery primarly „ Limb-Saving “-Procedures (Revascularisation, Stabilise Fix. Ext) Minimize second hits

7. Damage control is more than only „Surgery “ Traumasurgery Neurosurgery Vizeralsurgery Thoraxsurgery Urology Anaesthesiology

8. Decision making Severe injured Pat needs Damage Control Surgery (DCS) ? In doubt– DCS ! How is the Patient? Criteria Coagulation Temperature Complexity

9. Resources limited Mass Casualty Military Missions More normal operations Personal ressources limited Day or night

10. Resources limited – Mission abroad Resources limited: Personell Room Infrastructure Material (blood) ICU

11. Scoop and Run in Pol e Khomri April 2010 Time to surgery ?

12. ASAP

13. Clarke, J. R., S. Z. Trooskin, P. J. Doshi, L. Greenwald and C. J. Mode (2002). "Time to laparotomy for intra-abdominal bleeding from trauma does affect survival for delays up to 90 minutes." J Trauma 52(3): 420-5. Die Wahrscheinlichkeit zu sterben, steigt alle 3 Minuten ca. um 1 %. Nach Überschreiten der Zeitgrenze von 1 Stunde bis zu einer Not-Op steigt die Wahrscheinlichkeit zu sterben signifikant an.

14. Navy & Marine Combat Trauma Registry n= 11.686 patients 81% within ONE hour Rapid Evacuation Multiple injured Pat.

15. Don ‘t touch the g olden h our o f s hock in t rauma - it is the good GHOST for bleeding soldiers and civilians

16. Damage control Surgery

17. 14.12.11 Seite Saturday in Johannesburg – a different Traumaload

18. Saturday in Johannesburg – Resources personnell limited

19. Multiple injured Pat Night German Level 1 Trauma Center Resources personnell not limited ! AC TC AC UC URO UC AC

20. Resources-related DCS Damage control under austere conditions = Reduction on „life and limb saving procedure “ Tactical Abbreviated Surgical Control (TASC)

21. Unfallchirurgie

22. Unfallchirurgie First evaluation of DSTC Videos Homburg Germany DSTC Course Mixture –Manual / Videos / Case Discussions/ Practical sessions May 2012 DVD DSTC Course / web applications / randomized controlled world wide study

23. Unfallchirurgie Is Damage Control important for Disaster missions? Prepare the Individuum and the System. Haiti 60% of medical infrastructure destroyed. 10% of medical personal dead. Rapid Response force for disaster missions DITAC