Road traffic crashes alone kill around 1.2 million people every year, according to WHO, with the greatest burden in low- and middle-income countries. Falls, violence and burns add to the toll. Many trauma deaths happen in the first hours, and many are preventable with a rapid, systematic approach. The trauma primary survey identifies and treats immediately life-threatening problems in order of priority.
<C>ABCDE
<C> Catastrophic haemorrhage
Massive external bleeding kills fastest, so it comes first in many trauma systems. Control with direct pressure, wound packing, pressure dressings, or a tourniquet for limb bleeding. See haemorrhage control.
A – Airway with cervical spine protection
- Is the patient talking? If yes, the airway is currently open.
- Look for blood, vomit, broken teeth, facial fractures, burns.
- Use a jaw thrust (not head tilt) if spinal injury is possible; suction; airway adjuncts.
- Maintain spinal precautions where indicated. See spinal precautions.
B – Breathing
- Respiratory rate, SpO₂, chest movement, breath sounds.
- Look for life-threatening chest injuries: tension pneumothorax, open pneumothorax, massive haemothorax, flail chest.
- Give high-flow oxygen as per protocol; prepare for chest decompression or chest drains. See chest drain care.
C – Circulation
- Heart rate, blood pressure, capillary refill, skin colour, consciousness.
- Look for hidden bleeding: chest, abdomen, pelvis, long bones (“blood on the floor and four more”).
- Two large-bore IV or intraosseous access; bloods including crossmatch.
- Blood products and tranexamic acid (ideally within 3 hours of injury) per major haemorrhage protocols.
- Pelvic binder if pelvic fracture suspected.
- Avoid excessive crystalloid fluids. See recognising shock.
D – Disability
- GCS or AVPU, pupils, limb movement.
- Blood glucose.
- See head injury observations.
E – Exposure and environment
- Fully expose to look for injuries (log roll to check the back), while protecting dignity.
- Prevent hypothermia: warm blankets, warmed fluids. Hypothermia worsens bleeding.
The nurse’s role in the trauma team
- Prepare the resuscitation area and equipment before arrival.
- Take a structured pre-hospital handover (e.g. ATMIST: Age, Time, Mechanism, Injuries, Signs, Treatment).
- Obtain observations and IV access; administer medicines and blood products.
- Scribe and record times.
- Communicate with family and provide psychological support.
- Prepare for transfer to theatre, CT or ICU.
Prevention
Helmets, seatbelts, child car seats, speed limits and not drink-driving save lives. Nurses can advocate in their communities.
Based on ATLS principles, WHO Basic Emergency Care course, NICE NG39 (Major trauma) and WHO road traffic injury fact sheet. Educational content: follow local trauma protocols.