Improvement in pre hospital care and trauma resuscitation has increased chances of early survival of injured patients who would have succumbed at the accident scene or enroots to the hospital. Rapid surgical “bail out” tactics (damage control) are the only option. Damage control is a surgical strategy that sacrifices the completeness of the immediate repair in order to address adequately the combined physiological impact of trauma and surgery. Hypothermia, coagulopathy, metabolic acidosis and dysrhythmia characterizes the impending dangers in long surgeries often required in poly trauma cases. Limited operation for control of hemorrhage and contamination: it includes control of hemorrhage from the heart or lung, conservative management of injuries to solid organs, resection of major injuries to the gastro intestinal tract without re-anastomosis, control of hemorrhage from major arteries and veins in the neck, trunk or extremities, packing of organ or spaces to control the inevitable coagulopathy and use of an alternate closure of a cervical incision, thoracotomy, laparotomy or site of exploration of an extremity. Resuscitation in the surgical ICU: it includes vigorous rewarming of the hypothermic patient, restoration of a normal cardiovascular state by the infusion of fluids and blood and use of inotropic and related drugs, correction of residual coagulopathy after hypothermia is reversed and supportive care for the insulted lungs and kidneys. Re-operation: this relates to completion of definitive repairs, search for missed injuries and formal closure of the incision if possible. Complications are ongoing bleeding, missed enteric injury resulting in systemic inflammatory response syndrome and shock, development of abdominal compartment syndrome.