In the National Audit Office's 2010 report on major trauma care in England, it was estimated that there are 20,000 cases of major trauma per year in England. Each year, 5,400 people die of their injuries and many others sustain permanent disability. Every trauma death costs the nation in excess of £0.75 million and every major injury £50,000.

Regional trauma networks were developed across England from April 2012. Within these networks major trauma centres provide specialised care for patients with multiple, complex and serious major trauma injuries, working closely with local trauma units.

The initial assessment of a patient with major trauma is directed at rapid identification of life‑threatening or life‑changing injuries. Clinicians conduct a rapid primary survey using a prioritising sequence, such as <C>ABCDE (catastrophic haemorrhage, airway with spinal protection, breathing, circulation, disability [neurological] and exposure and environment). People with suspected major trauma are usually taken to the nearest major trauma centre for management.

This guideline covers the initial assessment and management of major trauma, including airway, breathing and ventilation, circulation, haemorrhage and temperature control. It provides recommendations on:

  • airway management

  • management of chest trauma

  • management of haemorrhage

  • imaging

  • documentation

  • information and support for patients with major trauma and their families and carers.