SOC → SCF-DBI Logic Translation

Purpose

Damage-Control Resuscitation (DCR) is the resuscitative phase that occurs after the Primary Trauma Survey identifies hemorrhagic shock or impending physiologic collapse.

SOC Objective:

Prevent and reverse the “Lethal Triad” (or Trauma Diamond):

1. Hemorrhage
2. Coagulopathy
3. Hypothermia
4. Acidosis

The goal is not immediate physiologic normalization but preservation of life until definitive hemorrhage control can be achieved.

SOC Framework

SCF-DBI Translation

Core SCF Concept

SOC treats DCR as:

Blood loss → Shock → Resuscitate

SCF-DBI treats DCR as:

Endothelial Injury → Perfusion Collapse → Cellular Distress → Systemic Failure Cascade

The SCF-DBI model expands monitoring from simple vital signs into a multi-domain physiologic intelligence system.

SCF-DBI Trauma Collapse Architecture

Tier 1

Vascular Injury Phase

SOC Focus

Visible bleeding

SCF-DBI Focus

Endothelial integrity failure

The endothelium becomes the earliest organ injured during trauma.

Microvascular dysfunction often precedes overt shock.

SCF-DBI Monitoring Layer

DBI Interpretation

Tier 2

Perfusion Failure Phase

SOC Assessment

• Blood pressure
• Heart rate
• Capillary refill

SCF-DBI Assessment

Perfusion Reserve Analysis

Additional SCF Metrics

Lactate Delta Logic

SOC:

Single lactate value

SCF-DBI:

Rate of lactate clearance

Formula:

Δ Lactate = Lactate(T0) − Lactate(T1)

Interpretation

Tier 3

Autonomic Collapse Assessment

SOC

Heart rate only

SCF-DBI

Autonomic Nervous System Integrity

Heart Rate Variability (HRV)

Why HRV Matters

Heart rate alone is a late marker.

Loss of variability frequently precedes:

• Hypotension
• Cardiovascular collapse
• Multiple-organ dysfunction

SCF-DBI HRV Classification

DBI Logic

HRV becomes:

Early Collapse Predictor

rather than merely a cardiovascular measurement.

Tier 4

Immunologic Injury Phase

SOC

Typically not assessed during initial DCR.

SCF-DBI

Trauma-Induced Immune Dysregulation Monitoring

Cytokine Trajectory Monitoring

SCF-DBI tracks inflammatory momentum.

Not simply:

How inflamed is the patient?

But:

Is inflammation accelerating or resolving?

Key Biomarkers

Cytokine Trajectory States

Tier 5

Metabolic Recovery Phase

SOC

Correct acidosis

SCF-DBI

Cellular Recovery Assessment

Domains

SCF-DBI Damage-Control Resuscitation Workflow

Step 1

Control hemorrhage.

Output

Bleeding Status Score

Step 2

Initiate balanced transfusion.

Output

Hemodynamic Stability Score

Step 3

Assess endothelial injury.

Output

Endotheliopathy Severity Score

Step 4

Calculate lactate delta.

Output

Perfusion Recovery Score

Step 5

Evaluate HRV.

Output

Autonomic Reserve Score

Step 6

Assess cytokine trajectory.

Output

Inflammatory Risk Score

Step 7

Determine overall collapse state.

DBI Collapse Categories

Glossary

SCF-DBI Enhancement Summary

SCF Principle Alignment

• Targeted Action → Hemorrhage source elimination
• Pharmacokinetic Optimization → Oxygen delivery restoration
• Metabolic Efficiency → Lactate clearance and ATP recovery
• Resistance Prevention → Prevention of secondary inflammatory collapse
• Safety Profile → Early identification of decompensation before irreversible organ failure

INDEX

SCF-SURG-DCR-0001

SCF-DBI-ENDOTHELIOPATHY-0001

SCF-DBI-HRV-TRAUMA-0001

SCF-DBI-LACTATE-DELTA-0001

SCF-DBI-CYTOKINE-TRAJECTORY-0001

SCF-TRAUMA-RESUSCITATION-0002