Major trauma is a leading cause of death and disability in all age groups worldwide. It is categorised by its mechanism into blunt (e.g. falls, road traffic collisions) or penetrating injury (stabbings, shootings). Initial management utilises the ABCDE approach to identify and treat life-threatening injuries, active haemorrhage, shock and coagulopathy. Guidelines for trauma management have been issued by NICE (2016)^1,2

Practitioners should elicit a NATMIST (Table 44.1) and AMPLE handover3 (Box 44.1) from prehospital emergency services, witnesses and/or relatives as soon as possible after hospital admission.

Haemorrhage causes 40% of trauma-related deaths. Rapid control of catastrophic haemorrhage is the immediate priority in trauma and can be achieved quickly by applying dressings, direct pressure and elevating the wound. Tourniquets and haemostatic dressings may be used if simple measures fail to stop bleeding. A pelvic binder should be applied to patients with suspected pelvic fracture with signs of shock.