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 3-40A.7 (formerly MCRP 4-11.1G, Jul 2013)
- JTS CPG: Austere Resuscitative Surgical Care (ARSC) (30 Oct 2019)
- JTS CPG: Emergency General Surgery in Deployed Locations (Damage Control Surgery reference, 01 Aug 2018)
- JTS CPG: Damage Control Resuscitation (continued in OR, 12 Jul 2019)
- JTS CPG: Emergent Resuscitative Thoracotomy (ERT) (18 Jul 2018)
- JTS CPG: REBOA for Hemorrhagic Shock (03 Dec 2025)
- JTS CPG: Wartime Thoracic Injury (26 Dec 2018)
- JTS CPG: Anesthesia for Trauma Patients (05 Apr 2021)
- JTS CPG: Blunt Abdominal Trauma, Splenectomy, and Vaccination (13 May 2020)
- JTS CPG: Genitourinary Injury Trauma Management (29 Mar 2024)
- JTS CPG: Pelvic Fracture Care (17 Feb 2026)
- JTS CPG: TBI and Neurosurgery in the Deployed Environment (15 Sep 2023)
- JTS CPG: Emergency Cranial Procedures by Non-Neurosurgeons (10 Jun 2025)
- JTS CPG: Burn Care (10 Jun 2025)
- JTS CPG: Infection Prevention in Combat-related Injuries (27 Jan 2021)
- JTS CPG: UPAC Vaporizer and Mechanical Ventilation (Feb 2025)
- JTS CPG: Wound Management (PFC, 24 Jul 2017)
- JTS CPG: Extremity Compartment Syndrome and Fasciotomy (25 Jul 2016)
- JTS CPG: Vascular Injury (09 Apr 2025)
- JTS CPG: Open Abdomen Management (see JTS CPG library)
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).
- Aortic Occlusion Procedure Notes (REBOA/ERT).
- Post-operative handoff to Holding.
- Damage control follow-up plan for the receiving facility.
Reference Imagery
Educational Resources
Valkyrie Training — Walking Blood Bank Curriculum: valkyrietraining.org/curriculum Modules 1–7 apply directly to intraoperative blood management and donor screening before activation.
Presentations:
- Forward Resuscitative Surgical System (FRSS) — primary unit deck
- Damage Control Resuscitation Principles
- Tube Thoracostomy & Needle Decompression
- Surgical Cricothyrotomy
- eFAST Exam
- Regional Anesthesia in the Field
- Blood Products, Walking Blood Bank & MTP
SOPs: FRSS Operations SOP · Blood Management SOP · Sterilization SOP
⚠️ Gap: Anesthesia for austere environments — no dedicated Deployed Medicine module found. JTS CPG ID40 is the primary reference.
Last reviewed: • OPSEC reviewed: