title: Resuscitation and blood utilization guidelines for the multiply injured, multiple amputee.
abstract: Given the current tempo of overseas contingency operations, military orthopaedic surgeons are increasingly performing their duties in an austere environment. At Level 1 trauma centers and combat support hospitals, resources tend to be more abundant than in less "metropolitan'' locations. Combat casualty care has reinforced the idea of a multidisciplinary team approach to severely injured trauma patients. During mass casualty situations, as seen recently in Haiti and in the wake of Hurricane Katrina, all members of the trauma team may need to perform duties on the periphery of their comfort zone. Early involvement of orthopaedic surgeons in damage control surgery, as well as resuscitation, are critical to the survival of patients with high amputations, multiple amputations, open pelvic injuries, and mangled extremities common in high-energy penetrating and blast-induced trauma. This article introduces the concept of Damage Control Resuscitation to the orthopaedic surgeon, and also presents a treatment guideline for use as appropriate.
authors.affiliation: Department of Orthopaedics and Rehabilitation, Naval Medical Research Center, Walter Reed National Military Medical Center, Bethesda, MD, USA. keith.alfieri@med.navy.mil
authors.forename: Keith A
authors.initials: KA
authors.lastname: Alfieri
authors.forename: Eric A
authors.initials: EA
authors.lastname: Elster
authors.forename: James
authors.initials: J
authors.lastname: Dunne
mesh_terms: D000673:Amputation, Traumatic / Q000628:therapy*; D016913:Blood Component Transfusion / Q000379:methods* / Q000706:statistics & numerical data; D006801:Humans; D008887:Military Medicine; D009104:Multiple Trauma / Q000628:therapy; D012151:Resuscitation / Q000379:methods*