Here we examine DCR from a multidisciplinary perspective by integrating descriptions of the pathophysiology, of hemorrhage-associated coagulopathies and the extreme homeostatic imbalances that may appear during severe hemorrhage, or in the aftermath of resuscitation. A comprehensive understanding of cardiovascular physiological principles, hematological advances in hemostasis at a molecular and cellular level, the capabilities of the hematological laboratory, and developments in transfusion medicine is essential for successful treatment of severe bleeding. However, we emphasize that resuscitation of the patient in hemorrhagic shock is, in effect, a means to an end. Definitive control of bleeding is the principal objective in any comprehensive resuscitation scheme for hemorrhagic shock, and therefore DCR must not eclipse emergent endoscopic, surgical or angiographic intervention