When someone suffers a life-threatening injury, whether from a road accident, a fall or a violent assault, the actions taken in the first few minutes often determine whether they survive. A newly published expert consensus from China sets out updated guidance for paramedics and emergency responders on how to manage major trauma before a patient even reaches hospital, with the aim of reducing preventable deaths.
The consensus, developed by a multidisciplinary panel of Chinese emergency medicine, trauma surgery and prehospital care specialists, was published in the Chinese Journal of Traumatology. It brings together evidence from international guidelines, systematic reviews and clinical trials to create sixteen recommendations covering everything from scene safety to hospital handover.
Central to the guidance is what the authors call the xABCDE approach. This places control of catastrophic external bleeding, referred to as X, ahead of the traditional airway, breathing and circulation steps, reflecting growing recognition that uncontrolled haemorrhage is one of the most preventable causes of death after injury.
For severe limb bleeding, the panel recommends the prompt use of a commercial tourniquet applied above the wound. For bleeding in areas such as the groin or armpit, wound packing combined with sustained direct pressure is advised, with junctional tourniquets used where available. The guidance draws heavily on lessons learned from military trauma care, which has shaped much of modern civilian practice.
The consensus also endorses permissive hypotension, a strategy in which blood pressure is deliberately kept lower than normal in patients with uncontrolled bleeding, to avoid dislodging clots before they can reach surgery. However, for patients with a suspected brain injury, a higher blood pressure target is recommended to protect the brain from further damage.
Early use of tranexamic acid, a drug that helps blood clot and reduces bleeding related deaths, is strongly recommended within three hours of injury. The panel notes that giving this treatment later than three hours may do more harm than good, underlining the importance of speed in trauma response.
Older patients receive particular attention in the consensus, given that injury is now among the leading causes of death for elderly people in China. The guidance warns that older adults can appear stable despite serious internal bleeding, partly because medications such as beta blockers can mask the usual signs of shock.
Other recommendations cover pelvic binders for suspected pelvic fractures, careful use of spinal immobilisation devices, and a standardised handover process between ambulance crews and hospital staff known as ATMIST, which aims to prevent critical information being lost during the transfer of care.
The authors stress that the consensus is intended as a practical reference rather than a rigid rulebook, and that individual clinical judgement remains essential. They hope it will help standardise prehospital trauma care across China and, ultimately, improve survival rates for some of the most seriously injured patients.
