Introduction: initial management of abdominal and multisystem trauma presents a clinical challenge that requires a systematic and multidisciplinary approach. The Advanced Trauma Life Support (ATLS) protocol is an international standard that guides rapid evaluation and stabilization of trauma patients, improving survival and reducing complications. Objective: to detail the importance and application of the ATLS protocol and damage control in the initial management of abdominal trauma, emphasizing integration across general surgery, orthopedics, neurosurgery, and urology. Methodology: a narrative review of current scientific literature was conducted, analyzing relevant articles and guidelines on ATLS and damage control in abdominal and multisystem trauma from databases such as PubMed, Scopus, and Google Scholar. Studies addressing clinical implementation, outcomes, and challenges across surgical specialties were selected. Results: the ATLS protocol has proven effective in improving early assessment and stabilization, facilitating timely and coordinated surgical interventions. In general surgery, damage control decreases mortality due to hemorrhagic shock. In orthopedics, early fracture stabilization reduces systemic complications. In neurosurgery, rapid detection and management of traumatic brain injury improve neurological prognosis. In urology, early identification of genitourinary injuries prevents functional sequelae. However, challenges remain in the uniform implementation of the protocol, especially in resource-limited settings. Conclusions: ATLS and damage control are essential in the initial management of abdominal and multisystem trauma, integrating a multidisciplinary approach that enhances survival and reduces complications. Continuous training and adaptation of the protocol to diverse clinical contexts are vital to optimize outcomes in trauma patients.