Treatment of bleeding in the urban battlefield

Urban trauma centers care for horribly injured patients using an array of tools for hemostasis and stabilization. Over the last 20 years, damage control operative therapy, an approach that emphasizes prompt hemorrhage control, keeping patients warm, and prevention and prompt treatment of coagulopathy, has improved greatly outcomes for these patients. This article reviews the basic aspects of damage control operations, with particular reference to problems of hepatic and retroperitoneal bleeding; presents 3 illustrative cases; and reviews the results of the author’s collaboration in a study comparing the efficacy of platelet-enriched autologous plasma and bovine collagen and thrombin in reducing the need for blood transfusion in patients with retroperitoneal bleeding.