Prehospital evidence must be judged in the population and environment where it will be used. The programme separates evidence quality from recommendation direction, using pelvic binders and trauma ultrasound to show why routine adoption and reassurance from a negative scan both need caution.

The first ECMO decision in trauma is whether the dominant failure is gas exchange, circulation or uncontrolled haemorrhage. Veno-venous support suits refractory respiratory failure with preserved cardiac output, veno-arterial support can bridge selected circulatory collapse, and neither replaces rapid haemorrhage control or a rehearsed multidisciplinary system.

Emergency and trauma teams get an update on ATLS 11 and the move to XABCDE. Exsanguinating haemorrhage control, planned airway management, blood-product resuscitation, E-FAST, chest decompression, patient dignity, team pre-briefing and debriefing are integrated into the early trauma pathway.

Well-appearing head injury with GCS 13–15 and abnormal CT still needs structured disposition. mBIG sorts CT-confirmed skull fracture or intracranial bleeding by the highest-risk feature; the bedside anchor is repeated neurological examination backed by platelet, anticoagulant and measured CT detail.

Major trauma handover is the strongest first choice because it is immediately transferable to resuscitation practice. Open this before a trauma shift if stretcher-to-bay transfer, iMIST handover, crowd noise and ABC role clarity are recurring problems in the team.

Unstable torso bleeding asks a destination question before a procedure question. RAPTOR hybrid suites matter when pelvic arterial bleeding, liver bleeding, blunt aortic injury or junctional vascular injury may need operative control, endovascular control or both without unsafe transfers.