Trauma remains one of the leading causes of mortality and long-term disability worldwide, and in the context of ongoing full-scale hostilities in Ukraine has acquired exceptional medical, and social significance. Massive hemorrhage and the development of hemorrhagic shock are the main causes of death among the wounded during, underscoring the need for contemporary, pathophysiologically grounded approaches to anti-shock therapy.

The aim of this work is to summarize and provide a pathophysiological analysis of modern approaches to prehospital anti-shock therapy for combat trauma, in accordance with the Damage Control Resuscitation concept.

Materials and methods. The study was based on a systematic review and critical analysis of current scientific publications from PubMed, Scopus, Web of Science, and the Cochrane Library, as well as international tactical medicine guidelines, including the Tactical Combat Casualty Care recommendations.

Results. Modern concepts of the pathogenesis of hemorrhagic shock in combat trauma are summarized through the lens of the “lethal triad” and the expanded “diamond of death”. It is demonstrated that early hemorrhage control, restricted fluid therapy, hemostatic resuscitation with blood components, prevention of hypothermia, correction of hypocalcemia, and adequate analgesia are interrelated components of effective prehospital care. Particular emphasis is placed on the role of tranexamic acid as a pathogenetically justified agent for early correction of traumatic coagulopathy. The rationale for its administration at the prehospital stage is substantiated, taking into account the critical time-dependence of its clinical efficacy.

Conclusions. Integration of Damage Control Resuscitation principles into prehospital care protocols for combat trauma reduces physiological decompensation, lowers mortality, and improves outcomes at subsequent stages of treatment and medical evacuation. Further advancement of military medicine should focus on the standardization and practical implementation of comprehensive anti-shock algorithms adapted to the realities of combat operations.