Anaesthetic priorities in pre-hospital trauma care

Trauma is a significant cause of morbidity and mortality in the UK. Developments in the delivery of pre-hospital trauma care and advances in techniques for managing critically injured patients on scene, partly due to military medical experiences in recent conflicts, have encouraged greater scrutiny of the performance of these services. In addition to the unique environmental and logistical challenges posed by pre-hospital care, the injury and physiology patterns typically associated with trauma patients necessitate a specific approach to their assessment and treatment, whereby control of Catastrophic haemorrhage is prioritized before management of Airway, Breathing and Circulation issues (ABC). The time-critical casualty needs to be recognized, and immediate life- or limb-threatening complications addressed promptly, with expedited evacuation to definitive hospital care. In 2011 the General Medical Council (GMC) approved Pre-hospital Emergency Medicine (PHEM) as a subspecialty of Emergency Medicine and Anaesthetics, thereby highlighting it as an area of medical expertise which requires training of its practitioners, as well as demonstration of competent, evidence-based, and meticulously audited practice.