Early appropriate care (EAC) is a system inorthopaedictrauma surgery aiming to identify seriousmajor trauma patients and treat the mosttime-critical injuries without adding to their physiological burden.

EAC prescribes that definitive management of unstableaxial skeleton andlong bonefractures should only be undertaken within 36 hours if an adequate response toresuscitation has been demonstrated by:^{[citation needed]}

• pH ≥7.25
• Lactate ≤4 mmol/L
• Base excess > (less negative than) -5.5 mmol/L

Other factors such ascoagulopathy andhypothermia (parts of theTrauma triad of death) would also be indications for DCO withexternal fixation.^{[citation needed]}

Early total care (ETC) became widespread in the 1980s, when studies showed early definitivefixation oflong bonefractures lead to better outcomes, with a reduction in incidence of secondaryARDS,fat embolism andsepsis.^[1] Subsequent studies showed that in the unstable patient, long operations lead to a 'second hit' which actually worsenedmortality outcomes.

A philosophy ofdamage control orthopaedics (DCO) was proposed in 2000,^[2] aiming to prevent early death in a critically wounded patient via stabilization and not definitivefixation, often with the use ofexternal fixation systems.

EAC was developed byHeather Vallier while at MetroHealth in Cleveland.^[3] The term early appropriate care was first proposed in herJournal of Orthopaedic Trauma article in 2013^[3] as an evolution of DCO, with a focus onresuscitation rather thaninjury severity score.

• Damage control surgery

• Traumatology
• Trauma surgery

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