Remote Damage Control Resuscitation


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This course is developed and produced by the THOR organization.

For more information see THOR webpage:

About THOR

Battlefield resuscitation of hemorrhagic shock are constrained by many limitations in combat settings. Resuscitation strategy is changing towards early use of blood components and hemostatic agents. Dr. Geir Strandenes was employed as a medical director on unit level in the Norwegian Navy in 2010. He has since devoted much of his time to further develop this strategy together with Dr. Philip Spinella, Prof. Tor Hervig and CM Håkon Eliassen. The project was named Blood Far Forward and in order to consolidate and gather knowledge throughout the world we have formed a network:

THOR – The Hemostasis and Oxygenation Research Network

The Traumatic Hemostasis and Oxygenation Research (THOR) Network is a international multidisciplinary group of investigators with a common interest in performing research that aims to improve outcomes and safety in patients with severe traumatic injury through improved monitoring and resuscitation techniques. The Network’s focus on the optimal methods to identify and treat traumatic shock and coagulopathy are evidenced by its current work on advancing the measurement of tissue oxygenation, cellular shock, clot strength, and fibrinolysis as well as determining the optimal fluid and blood products that are needed for these patients. The research the Network performs includes both pre-hospital and hospital phases of care with attention to both military and civilian applications.

What is RDCR?

“RDCR is a concept envisioned for the use in the out of hospital  combat casualty care setting,in cases where severely wounded casualty with continuing non compressible torso hemorrhage (NCTH) face delays in evacuation to resuscitative surgical intervention. RDCR can also be applied for severe civilian trauma especially for circumstances where there are prolonged evacuation times. RDCR is anchored in the principles of Tactical Combat Casualty Care (TCCC), beginning with the identification of life-threatening conditions followed by the appropriate and timely  performance of Life Saving Interventions (LSI)  before tactical evacuation, with care continuing en route to resuscative surgery and theater hospitalization. In cases of NCTH when standard prehopital intervention have been exhausted, the RDCR algorithm would seek to further mitigate end-organ hypoxia  and the” lethal triage” through the judicious employment of blood products,procoagulants and antifibrinolytic agents by far-forward combat medical personnel, leveraging remote decisions support technology and emergency telemedical reach- back to a specialist capable of providing informed medical direction.”

Analysis of Life-Saving Interventions Performed by Out-of-Hospital Combat Medical Personnel
Robert T. Gerhardt, MD, MPH, FACEP, Johnathon A. Berry, DO, and Lorne H. Blackbourne, MD, FACS

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