When the first edition of the Trauma Care Manual was published in 2001, we wrote that it had been prepared to ‘begin the process of establishing United Kingdom guidelines for best practice in the management of major trauma’ and expressed a wish that it and future editions would be recognised as ‘definitive statements of best practice’. So it has turned out. A second edition of the Trauma Care Manual appeared in 2009, and a third edition, focused on care of the victim of trauma in hospital is currently being prepared. This volume, the Trauma Care Pre-Hospital Manual, builds on the earlier books and, like them, offers evidence-based guidelines for the management of major trauma, written by clinicians with many years of trauma experience, and endorsed as authoritative by Trauma Care (UK). As its title suggests, it deals with the management of trauma in the pre-hospital environment and thus complements the upcoming third edition of the Trauma Care Manual.
In 2001, few if any of those most involved in the care of victims of trauma could have anticipated the changes and developments that have occurred in the years that followed. The UK now has functioning (and on the evidence to date) effective trauma systems and networks, and clinical developments include the introduction of damage control resuscitation, tranexamic acid, blood product resuscitation, hybrid resuscitation and an emphasis on the control of major external haemorrhage as part of a new ABCDE approach. As a consequence, more patients with major trauma are surviving than ever before. Much of this change has been led by experience from recent conflicts in Iraq and Afghanistan. If this experience has taught one thing more emphatically than any other, it is that optimal pre-hospital care is essential if survival rates are to be improved and morbidity reduced. We are more aware than ever that trauma victims do not, in a sense, die from the trauma, but from the effects of trauma. These include hypoxia, acidosis, embolism, haemorrhage, abnormal clotting, hypothermia, metabolic and immunological derangement. The sooner these harmful processes are arrested (or better still prevented), the better outcomes will be. It is the recognition of this concept as the key to trauma management that underpins these guidelines.