Table 5 Suggested management bundles

• Pre-hospital time minimised

• Tourniquet employed in case of life-threatening bleeding from extremities

• Damage control resuscitation concept applied

• Trauma patient transferred directly to an adequate trauma specialty centre

• Full blood count, prothrombin time, fibrinogen, calcium, viscoelastic testing, lactate, BE and pH assessed within the first 15 min

• Immediate intervention applied in patients with haemorrhagic shock and an identified source of bleeding unless initial resuscitation measures are successful

• Immediate further investigation undertaken using focused assessment with sonography for trauma (FAST), computed tomography (CT) or immediate surgery if massive intra-abdominal bleeding is present in patients presenting with haemorrhagic shock and an unidentified source of bleeding

• Damage control surgery concept applied if shock or coagulopathy are present

• Damage control resuscitation concept continued until the bleeding source is identified and controlled

• Restrictive erythrocyte transfusion strategy (haemoglobin 7–9 g/dl) applied

• Tranexamic acid administered as early as possible

• Acidosis, hypothermia and hypocalcaemia treated

• Fibrinogen maintained at 1.5–2 g/l

• Platelets maintained at >100 × 10⁹/l

• Prothrombin complex concentrate administered in patients pre-treated with warfarin or direct-acting oral coagulants (until antidotes are available)