Physician-staffed helicopter and ambulance medical services are becoming common throughout Japan as the importance of physician-provided prehospital trauma care has become recognized. The damage control concept was initially a surgical strategy for severe abdominal injury that developed into a fundamental concept of trauma care for severely injured patients comprising prehospital care, initial resuscitation, surgery, and intensive care. As the importance of a damage control concept in prehospital care and initial resuscitation became recognized, a new paradigm in prehospital trauma care, termed damage control ground zero was established. This initial response includes damage control resuscitation in prehospital settings, such as rapid control of hemorrhage, airway management, permissive hypotension, hemostatic resuscitation, and prevention of hypothermia. The strategies in prehospital settings differ from those within the hospital, but both share the concept of performing life-saving actions.

　　When it is difficult to perform a surgical approach to the bleeding site for penetrating carotid artery injuries of the neck, intravascular placement of a covered stent (carotid artery stenting) is sometimes useful. We encountered a case in which a stab injury of the extracranial carotid artery caused massive hemorrhage, the patient experienced hemorrhagic shock, and we could not save the patient’s life without continuing emergency transfusion. We chose intravascular placement of a covered stent instead of surgical treatment, and obtained excellent outcomes. In cases of torrential bleeding with impending death, similar to this case, intravascular treatment using a covered stent may be useful and must be adopted more often.