It is possible that recombinant activated factor VII (rFVIIa) could revolutionize the medical and surgical management of haemorrhage following trauma due to its ease of administration and mechanism of action. This article reviews the evidence for the use of rFVIIa as a procoagulant, its mechanism of action and its potential role in blunt and penetrating trauma. The role of rFVIIa in the emergency room or operating theatre and in the pre-hospital environment is discussed. Administration of rFVIIa `at the roadside’ may have signifi cant potential implications, especially for the trauma surgeon and even for strategic planners. Finally, the areas where further research is needed to provide objective evidence of its effi cacy are elaborated.
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