Objective: To investigate the clinical efficacy of damage control resuscitation (DCR) combined with pelvic binder fixation in the treatment of severe pelvic fracture-related hemorrhagic shock. Methods: A prospective randomized controlled trial was conducted on 182 patients with unstable pelvic fractures and hemorrhagic shock admitted to our hospital from March 2019 to April 2023. Patients were randomly assigned to the DCR group (n=91) and the conventional resuscitation (CR) group (n=91). The DCR group received balanced blood product transfusion (plasma:red blood cells:platelets = 1:1:1), permissive hypotension, and early pelvic binder fixation. The CR group received traditional crystalloid fluid resuscitation and delayed pelvic fixation. Primary outcome measures included 24-hour hemostasis success rate, 30-day mortality, and multiple organ dysfunction syndrome (MODS) incidence. Secondary outcomes included length of ICU stay, total blood transfusion volume, and complication rates. Results: The 24-hour hemostasis success rate in the DCR group was significantly higher than that in the CR group (86.8% vs. 65.9%, P<0.001). The 30-day mortality rate (12.1% vs. 27.5%, P<0.01) and MODS incidence (16.5% vs. 34.1%, P<0.01) in the DCR group were significantly lower than those in the CR group. The DCR group also had shorter ICU stay (5.2 ± 1.8 days vs. 8.7 ± 2.5 days, P<0.001) and less total blood transfusion volume (12.4 ± 3.6 units vs. 18.9 ± 4.2 units, P<0.001). The incidence of coagulopathy and acute respiratory distress syndrome (ARDS) in the DCR group was significantly lower than that in the CR group (P<0.05). Conclusion: Damage control resuscitation combined with early pelvic binder fixation can effectively control hemorrhage, reduce mortality and MODS incidence, and improve the prognosis of severe pelvic fracture-related hemorrhagic shock patients.