Uncontrolled external haemorrhage, though rare in civilian practice, is responsible for up to 80% of pre-hospital deaths in military trauma. Data from recent conflicts shows that exsanguination before evacuation accounts for 50% of deaths. Severe haemorrhage leads to the lethal triad of acidosis, hypothermia and coagulopathy. A new treatment paradigm, <C>ABC (where <C> stands for ‘Control of catastrophic haemorrhage) has been used to prioritise management of external haemorrhage. This approach has been augmented by the use of elastic field dressings, tourniquets and haemostatic agents. A ‘ladder’ approach is used to ensure basic wound management techniques are adopted before more sophisticated ones. Early fluid replacement via intraosseous needles and using blood and other blood products in the pre-hospital environment are other strategies used to achieve early haemostasis.
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