Damage control surgery (DCS) and tactical abbreviated surgical care (TASC) in thoracoabdominal trauma : Courses and consequences

Chirurgie (Heidelb). 2026 Jul 14. doi: 10.1007/s00104-026-02543-9. Online ahead of print.

ABSTRACT

The management of hemodynamically unstable critically injured trauma patients requires specialized expertise in acute surgical care and prioritization. In crisis and disaster scenarios or mass casualty incidents, these demands are further intensified by limited resources, time pressure and organizational complexity. The concepts of damage control surgery (DCS) and tactical abbreviated surgical care (TASC) describe patient-adapted and situation-adapted strategies focused on immediate life-saving interventions, rapid stabilization and limitation of further physiological deterioration, with definitive surgical treatment deferred to a later stage. While these approaches are taught as standardized procedures internationally and within the military, they remain insufficiently integrated into civilian surgical education in Germany. Current surgical specialist (“Facharzt”) curricula predominantly emphasize elective procedures performed under optimal conditions and provide limited training in temporary damage control techniques, surgical prioritization under resource constraints and the management of multiple critically injured patients simultaneously. Given the rarity of such situations, these competencies cannot be solely acquired in routine clinical practice. To date, there is no dedicated specialist training pathway in emergency and acute care surgery in Germany. Existing stand-alone course formats, including definitive surgical trauma care (DSTC), advanced surgical skills for exposure in trauma (ASSET), acute care in trauma (ACT!) or terror and disaster surgical care (TDSC®), address only selected aspects of the required skill set. The introduction of the DGU training program “Emergency surgeon – Crisis and disaster situations” in 2024 represents the first structured national curriculum specifically designed for these scenarios. In future, a mandatory training framework is required that integrates surgical, tactical and organizational skills. Emergency and acute care surgery should be more firmly established as a system-relevant core competency within surgical curricula, institutional structures and healthcare policy.

PMID:42446646 | DOI:10.1007/s00104-026-02543-9