Trauma is one of the leading causes of death worldwide.  In Canada, trauma is the leading cause of death in people under age 45 and accounts for approximately 16,000 deaths per year.  Despite advances in trauma resuscitation, hemorrhage, shock, and coagulopathy remain the main drivers of preventable death after trauma and are responsible for over 40% of all trauma-related deaths.

Initiation of “damage control resuscitation” in the out-of-hospital environment has the potential to reduce complications associated with hemorrhage by intervening at the point of injury and preventing or limiting the development of 'Acute Coagulopathy of Trauma-Shock' (ACoTS).  Adopted from damage control surgery, damage control resuscitation prioritizes rapid definitive hemorrhage control, permissive hypotension (in select patients), the minimal use of crystalloid fluid, and timely delivery of balanced blood products.

• Rapidly obtain definitive hemorrhage control.
• Maximize tissue oxygenation.
• Prevent or limit the development of hypothermia.
• Minimize the use of crystalloid fluid for volume replacement.
• Initiate rapid conveyance to an appropriate lead trauma hospital or utilize clinical pathway.

• Triage according to the Pre-hospital Triage and Transport Guidelines for Adult and Pediatric Major Trauma decision tool, including Physiological Criteria, Anatomical Criteria, Mechanism of Injury Criteria, and Special Considerations.

• Assessment and stabilization should follow the CABCDE pattern: Circulation, airway, breathing, circulation, disability (neurologic status), exposure.

General Major Trauma Care