Rescue, resuscitation, repair, and rehabilitation are indispensable for the success of trauma treatment. Each of these phases has factors that need to be performed rapidly. During the rescue phase, rapid triage and pre-hospital treatment enable the right patient to be taken to the right place at the right time. The following are used during the resuscitation phase : rapid infusion and prompt transfusion for treating circulation disturbance and coagulopathy caused by exsanguinating hemorrhage ; real-time blood-chemical and imaging tests for diagnosing systemic severity and detecting injury sites. Early neurological protection for traumatic brain injury to prevent fatal brain swelling and prompt surgical decisions and advanced skills for successful damage control surgery are also essential. Immediate acute phase rehabilitation and posttraumatic stress disorder treatment and smooth transition from acute to recovery phase rehabilitation are important during rehabilitation. For effective trauma treatment, seamless transitions from pre-hospital to hospital and from phase to phase are also necessary. Additionally, we have reviewed the literature on current treatments and the future prospects of organ transplantation and regenerative medicine for trauma treatment.
The aim of this review is to summarize the current situation of trauma resuscitation. Opinions on resuscitation for severe trauma with hemorrhagic shock have changed internationally in recent years. The current strategies for trauma resuscitation are restrictive fluid resuscitation, i.e. permissive hypotension, hemostatic resuscitation with blood components, blind protocol-driven administration of coagulation factors (begun early), and abbreviated initial surgery (damage control) or planned definitive surgery after resuscitation is complete, or angioembolization if needed.
So-called "damage control resuscitation" is the basic concept of these strategies. When it is adopted in Japan, the work of many skilled individuals, such as acute care surgeons, interventional radiologists, anesthesiologists and intensive care physicians will need to be integrated, as well as all resources needed for trauma care in a specialized medical facility for severely injured patients, that is, a trauma center. It is difficult to introduce a Western-style trauma care system in Japan because the Japanese medical system is quite different ; however, we hope that a trauma center adapted to Japan will be constructed soon and more qualified trauma care will be available to injured patients at all times in order to save lives.