Anaesthetic priorities in pre-hospital trauma care

The approach to pre-hospital trauma care has undergone some changes in recent years. Some of the lessons have been learnt from the military as a direct result from experiences in recent conflicts. Personnel involved in pre-hospital care need to be aware of the dangers at the scene and have the ability to work with and liaise with other emergency services. Control of any massive haemorrhage needs to be gained as a priority before moving on to the more familiar Airway, Breathing and Circulation approach. The time-critical casualty needs to be recognized and any immediate life- or limb-threatening complications dealt with in the shortest possible time before expedited evacuation to a hospital that can provide definitive care.In addition human factors and crew resource management must be considered. Furthermore with the introduction of a formal training curriculum the requirement for robust evidence and clinical governance is pressing.