Hostile Environment Surgery: Damage Control for Combat Trauma

This lecture follows the transition from civilian surgery to combat trauma care during the first months of the full-scale war, when wounded civilians and soldiers were treated near the front line under shelling, blackouts, water shortages, and constant resource constraints. It is a grounded, experience-based look at how surgical thinking changes in a hostile environment: from definitive operations to damage control, from comfort to improvisation, and from routine workflows to survival-driven algorithms.

The speaker walks through the practical management of head, face, neck, chest, abdominal, vascular, and limb injuries, with special attention to airway control, thoracostomy and thoracotomy, temporary vascular shunting, fasciotomy, fracture stabilization, amputations, lavage and debridement, and the logic of when not to overoperate. A large part of the talk focuses on what made the difference in real practice: light, suction, electrosurgery, portable ultrasound, FAST, vascular access, nerve blocks, warming strategies, monitoring, organization of consumables, and teamwork under fire.

The session also connects frontline experience with lessons from HEST training and surgery in resource-limited conflict settings. Beyond general principles, it is packed with field-tested details, equipment choices, and hard-earned clinical judgment that are especially valuable for young surgeons learning how damage control actually looks outside the textbook.