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Polytrauma & critical haemorrhage

Trauma & Environment

For healthcare professionals. This information does not replace clinical judgement in the individual case; the current summary of product characteristics and the guidelines cited are authoritative.

Medically reviewed: Dr. med. univ. Daniel Pehböck, DESA, 03.11.2026

Polytrauma & critical haemorrhage: Scene and priorities, xABCDE (ATLS 11) – also cABCDE, Critical haemorrhage, Circulation – permissive hypotension, fluids, blood, Tranexamic acid and coagulation, Chest trauma – concise for emergency, anaesthesia and intensive care teams, with sources and medically reviewed.

What the chapter covers

  1. Scene and priorities
  2. xABCDE (ATLS 11) – also cABCDE
  3. Critical haemorrhage
  4. Circulation – permissive hypotension, fluids, blood
  5. Tranexamic acid and coagulation
  6. Chest trauma
  7. Spine – selective immobilisation
  8. Traumatic cardiac arrest (ERC 2025)
  9. Airway, anaesthesia, analgesia, TBI
  10. Receiving hospital, resuscitation room, handover

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Sources and guidelines

  1. Deutsche Gesellschaft für Unfallchirurgie (DGU) et al. S3-Leitlinie Polytrauma/Schwerverletzten-Behandlung, Fassung 2016 (Vorgängerfassung, AWMF-Register 012-019)
  2. Trentzsch H, Goossen K, Prediger B et al. „Stop the bleed“.
  3. Prehospital coagulation management and fluid replacement therapy in patients with multiple and/or severe injuries.
  4. Inhospital coagulation management and fluid replacement therapy in patients with multiple and/or severe injuries.
  5. Prehospital management of chest injuries in severely injured patients.
  6. Rossaint R, Afshari A, Bouillon B et al. The European guideline on management of major bleeding and coagulopathy following trauma.
  7. Lott C et al. European Resuscitation Council Guidelines 2025: Special Circumstances in Resuscitation. Resuscitation 2025;215 Suppl 1:110753.
  8. Kurzfassung der Leitlinien des European Resuscitation Council 2025. Notfall Rettungsmed 2025.
  9. Resuscitation Council UK. Traumatic cardiac arrest algorithm.
  10. Djakow J, Turner NM, Skellett S et al. European Resuscitation Council Guidelines 2025 Paediatric Life Support. Resuscitation 2025;215 Suppl 1:110767.
  11. American College of Surgeons Committee on Trauma. Advanced Trauma Life Support (ATLS), 11th edition, 2025.
  12. Committee on Tactical Combat Casualty Care (CoTCCC). TCCC Guidelines.
  13. Brain Trauma Foundation. Guidelines for Prehospital Management of Traumatic Brain Injury, 3rd Edition (Lulla A et al.). Prehosp Emerg Care 2023;27(5):507–538; Executive Summary: Hawryluk GWJ et al. Neurosurgery 2023;93(6):E159–E169.
  14. CRASH-3 trial collaborators. Effects of tranexamic acid on death, disability, vascular occlusive events and other morbidities in patients with acute traumatic brain injury (CRASH-3)
  15. Maschmann C, Jeppesen E, Rubin MA, Barfod C. New clinical guidelines on the spinal stabilisation of adult trauma patients.
  16. Ruhigstellung der Halswirbelsäule in der Präklinik. Notfall Rettungsmed 2023 (Übersicht auf Basis der S3-Leitlinie 187-023: Immobilisation beim Polytrauma indiziert; Zervikalstütze bei SHT kritisch.
  17. Hoffman JR, Mower WR, Wolfson AB et al. (NEXUS). Validity of a set of clinical criteria to rule out injury to the cervical spine in patients with blunt trauma. N Engl J Med 2000;343:94–99.
  18. Stiell IG, Wells GA, Vandemheen KL et al. The Canadian C-spine rule for radiography in alert and stable trauma patients. JAMA 2001;286:1841–1848.
  19. Deutsche Gesellschaft für Transfusionsmedizin und Immunhämatologie (DGTI). Pressemitteilung 24.01.2024 zur präklinischen Transfusion (Projekt HeliBlut) bzw. Deutsches Ärzteblatt 26.01.2024.
  20. Crombie N, Doughty HA, Bishop JRB et al. Resuscitation with blood products in patients with trauma-related haemorrhagic shock receiving prehospital care (RePHILL)
  21. Sperry JL, Guyette FX, Brown JB et al. Prehospital plasma during air medical transport in trauma patients at risk for hemorrhagic shock (PAMPer). N Engl J Med 2018;379:315–326.