Hemorrhagic shock and lethal massive hemorrhage are leading causes of death in both combat and civilian trauma casualties, accounting for more than 80% of deaths in operating rooms and 70% of deaths within 24 hours after trauma. Management of such patients is the main challenge and core competence in establishment of a trauma center. Damage-control resuscitation measures in pre-hospital settings include following ABCs rules, implementing appropriate transfusion and infusion strategies based on pre-hospital transport time, maintaining blood pressure based on a specific injury, and using tranexamic acid. The core of damage-controlled resuscitation in in-hospital settings is early correction of traumatic coagulopathy by massive transfusion. Damage-control surgery in pre-hospital settings consists mainly in cervical spine protection, pelvic band fixation, thoracic drainage, direct compression hemostasis, etc. Resuscitation aortic balloon occlusion for non-compression lethal hemorrhage is the most promising life-saving means. Damage-control surgery in in-hospital settings includes damage control laparotomy, thoracotomy, orthopedic surgery and craniotomy. Only a combination of damage-control surgery and damage-controlled resuscitation in prime time can ultimately save patients with such severe trauma.