FRSS / DCS
Mission
The Forward Resuscitative Surgical System (FRSS) delivers Damage Control Surgery (DCS) — abbreviated, focused operative intervention to control surgical hemorrhage, control gross contamination, and create a temporary closure that allows the casualty to be moved to the next echelon for definitive surgical care. The FRSS does not deliver definitive surgery. The FRSS keeps people alive long enough to reach definitive surgery.
Personnel & Task Organization
Cross-training spans nursing, anesthesia, surgical assist, and OR turnover. The team is small enough that every member is on every case.
CRM in the operating room is non-negotiable: surgical pause, closed-loop verification of patient identity, planned procedure, allergy and blood availability, and explicit communication of intra-operative decision changes.
Equipment & Logistics
Operating room:
- Modular OR table; lighting; suction.
- Anesthesia machine and gas supply, or TIVA capability where gas is unavailable.
- Cautery, basic and vascular instrument sets.
- Sterilization (autoclave; chemical disinfection where applicable).
Surgical capability:
- General surgery, with vascular and orthopedic damage-control capability per training and equipment allowance.
- REBOA (where within scope and trained).
- Limited specialty surgery (neurosurgery, cardiothoracic) is generally not within FRSS scope; route to higher echelon.
AMAL:
Doctrinal References
- MCRP 4-11.1G
- JTS CPG: Damage Control Surgery
- JTS CPG: Damage Control Resuscitation (continued in OR, 12 Jul 2019)
- JTS CPG: Wound Management
- JTS CPG: Compartment Syndrome
- JTS CPG: Vascular Injury (09 Apr 2025)
- JTS CPG: Open Abdomen Management
Clinical Practice Guidelines
DCS bundle. Decision frameworks for abbreviated laparotomy and temporary closure.
Decision Points
| Decision | Trigger | Outcome |
|---|---|---|
| Damage control vs definitive | Physiological derangement (acidosis, hypothermia, coagulopathy), tactical urgency, multiple casualties | Damage control: control hemorrhage, control contamination, temporary closure, transport |
| Abbreviated laparotomy | Damage control criteria | Pack; ligate or shunt; temporary abdominal closure |
| Temporary closure technique | Per current CPG and local equipment | Negative pressure where available; Bogota bag where not |
| Limit surgical scope | Sustained operations; depleted blood; second incoming casualty wave | Pause and reassess; consider transfer-out earlier |
| Convert to definitive | Stable physiology; no incoming casualties; equipment and blood supply intact; patient cannot be safely evacuated | Single-stage definitive closure with awareness of risk |
| Post-operative disposition | End of operative phase | Holding for stabilization or direct EVAC depending on transport timeline |
Linked ELOs
| TLO | ELO | Primary or Secondary |
|---|---|---|
| Clinical Ops | CO-7 (equipment familiarization) | Primary |
| Clinical Ops | CO-8 (medical equipment maintenance) | Primary |
| Clinical Ops | CO-10 (blood management — surgical context) | Primary |
| Clinical Ops | CO-14 (clinical decision-making) | Primary |
| Team Development | TD-2 (cross-training) | Primary |
| Team Development | TD-4 (CRM) | Primary |
| Team Development | TD-9 (task org FRSS) | Primary |
| Prepare to Receive | PR-15 (surgical rehearsal) | Primary |
Forms & Documentation
- Operative note.
- Anesthesia record.
- Surgical safety checklist (WHO-style or local equivalent).
- Post-operative handoff to Holding.
- Damage control follow-up plan for the receiving facility.
Reference Imagery
Last reviewed: • OPSEC reviewed: