Over the last 25 years, many advances have resulted in improved survival of severely injured patients in multiple-casualty incidents. Some of the most important are the development of trauma centers and trauma systems and improved proficiency of surgeons with severe injury management. The cornerstone of surgical practice remains the care of the patient with a surgical emergency and the provision of an emergency operation where appropriate. The ideal resuscitation strategy for multiply injured patients remains a topic of ongoing debate.

This is a brief overview of the existing resuscitation protocols for multiply injured patients, including Advanced Trauma Life Support and damage control, and it will address evolving controversies in the field. A damage control approach was developed to improve survival in severely injured trauma patients. The role of damage control in the acute surgery of polytraumatized patients progressing to sepsis or overwhelming hemorrhage continues to be debated. These patients are best managed by a multidisciplinary team, which includes trauma surgeons, orthopedic surgeons, and interventional radiologists. Such an approach represents the challenge in multiple-casualty incidents, necessitating the development of standardized algorithms.