At a trauma call the anaesthetist secures the airway and shares the resuscitation, working in parallel with the rest of the team rather than in sequence. The Royal College of Anaesthetists states in GPAS chapter 16, the 2025 edition, that the anaesthetist's role extends beyond airway management to the recognition and management of acute physiological derangement, haemorrhage and shock. At the CT1 anaesthetics interview the trauma call is a scenario about priorities, blood and who leads.

Key takeaways

  • NICE NG39, published 17 February 2016, makes drug-assisted rapid sequence induction the definitive method of securing the airway in major trauma when the patient cannot maintain their airway or ventilation
  • If rapid sequence induction fails, NG39 says to use basic airway manoeuvres and adjuncts and a supraglottic device until a surgical airway or assisted tracheal placement is performed
  • Give intravenous tranexamic acid as soon as possible in active or suspected active bleeding, and not more than 3 hours after injury unless there is evidence of hyperfibrinolysis
  • In hospital, do not use crystalloids in a patient with active bleeding; NG39 asks for 1 unit of plasma to 1 unit of red blood cells and a fixed-ratio protocol first
  • GPAS chapter 16 says airway, breathing, circulation and cervical spine stabilisation should happen in parallel, and that anaesthesia for emergency control of major traumatic haemorrhage should be consultant anaesthetist led

What is the anaesthetist actually doing at a trauma call?

At a trauma call the anaesthetist takes the head of the bed, but the job is wider than the airway. The Royal College of Anaesthetists states in GPAS chapter 16 that the anaesthetist plays a key role in the multidisciplinary team and should provide input into the recognition and management of acute physiological derangement, haemorrhage and shock.

That matters for an answer, because a candidate who describes only intubation has described a third of the role. The College also says the trauma team should attend all suspected major trauma according to predefined local criteria, including for children and older patients.

What is the order of assessment in major trauma?

The order in major trauma is catastrophic haemorrhage first, then airway with in-line spinal immobilisation, breathing, circulation, disability and exposure. NICE NG39 records that sequence as <C>ABCDE in its documentation recommendations.

However, the Royal College of Anaesthetists is explicit that these steps run together. GPAS chapter 16 says initial management should follow adult trauma life support principles with management of airway, breathing and circulation, together with cervical spine stabilisation, occurring in parallel rather than in sequence.

ATLS is the course that teaches that structure. According to the American College of Surgeons, ATLS was first introduced in 1978, has been taught to more than 1 million clinicians in more than 80 countries, and its 11th edition was updated in 2025 to add team dynamics and family communication.

When does a trauma patient need a rapid sequence induction?

A trauma patient needs a rapid sequence induction when they cannot maintain their own airway or ventilation. NICE NG39 calls drug-assisted rapid sequence induction and intubation the definitive method of securing the airway in those patients.

  • NG39 asks for pre-hospital rapid sequence induction as soon as possible and within 45 minutes of the initial call to the emergency services, preferably at the scene
  • If it cannot be done at the scene, consider a supraglottic device if airway reflexes are absent, or basic manoeuvres and adjuncts if they are present
  • Transport to a major trauma centre for rapid sequence induction if the journey time is 60 minutes or less
  • Divert to a trauma unit only if a patent airway cannot be maintained or the journey exceeds 60 minutes
  • NICE NG40 says a patient should only be taken to a trauma unit if they need a life-saving intervention the pre-hospital team cannot deliver

GPAS chapter 16 lists the 45-minute rapid sequence induction as one of the NICE quality standards local policies should meet, alongside a provisional written radiology report within 60 minutes of urgent three-dimensional imaging.

What do you do if the trauma intubation fails?

If rapid sequence induction fails at a trauma call you fall back to oxygenation, not to a second heroic attempt. NICE NG39 says to use basic airway manoeuvres and adjuncts and a supraglottic device until a surgical airway or assisted tracheal placement is performed.

The Royal College of Anaesthetists says in GPAS chapter 16 that a standardised difficult airway trolley should be immediately available wherever these patients are managed, equipped as defined in the Difficult Airway Society guidelines, and that imaging suites receiving major trauma need immediate access to difficult airway equipment.

In an interview, saying 'I would declare the failed intubation out loud, oxygenate with a supraglottic device and ask for the consultant and the surgical airway kit' is a stronger answer than naming drugs. The trauma call rewards a declared plan B.

How is haemorrhage managed at a trauma call?

Haemorrhage at a trauma call is managed by stopping the bleeding and replacing blood, in that order. NICE NG39 asks for simple dressings with direct pressure first, a tourniquet in major limb trauma if pressure fails, and a purpose-made pelvic binder for suspected pelvic bleeding after blunt high-energy trauma.

  • Activate the major haemorrhage protocol on physiological criteria and the response to volume resuscitation, not on a risk score applied at a single time point
  • Reverse anticoagulation rapidly in a bleeding trauma patient, using prothrombin complex concentrate for a vitamin K antagonist in adults and never plasma
  • Consult a haematologist immediately for any anticoagulant other than a vitamin K antagonist, and for any anticoagulant in a child
  • Use damage control surgery in haemodynamic instability that is not responding to volume resuscitation
  • Use interventional radiology for active arterial pelvic haemorrhage unless immediate open surgery is needed for another bleeding site

GPAS chapter 16 says anaesthesia for the emergency control of major traumatic haemorrhage should be consultant anaesthetist led, and that where consultants are not resident there should be clear notification arrangements for early attendance at trauma calls.

What fluid does a bleeding trauma patient get?

A bleeding trauma patient gets blood components, not crystalloid, and gets them sparingly until the bleeding is controlled. NICE NG39 says to use a restrictive approach to volume resuscitation until definitive early control of bleeding has been achieved.

In hospital, NG39 says not to use crystalloids for patients with active bleeding, and to replace volume with 1 unit of plasma to 1 unit of red blood cells in adults. Start with a fixed-ratio protocol and move to laboratory-guided replacement at the earliest opportunity.

Pre-hospital, titrate to a palpable central pulse. That said, NG39 makes one exception: where traumatic brain injury is the dominant condition rather than haemorrhagic shock, use a less restrictive approach to maintain cerebral perfusion. Resuscitation Council UK's ABCDE guidance, updated July 2024, uses a smaller 250 ml crystalloid bolus in trauma.

When does tranexamic acid go in?

Tranexamic acid goes in as soon as possible in a trauma patient with active or suspected active bleeding. NICE NG39 is equally clear about the other end: do not give it more than 3 hours after injury unless there is evidence of hyperfibrinolysis.

NG39 noted in February 2016 that this was an off-label use of tranexamic acid. Saying 'as soon as possible, and not beyond 3 hours from injury without evidence of hyperfibrinolysis' is a complete answer to the question the assessor is actually asking.

Which imaging, and when?

Imaging at a trauma call is limited in the unstable patient and generous in the stable one. NICE NG39 says to limit diagnostic imaging to the minimum needed to direct intervention in suspected haemorrhage with haemodynamic instability not responding to volume resuscitation.

  • Use whole-body computed tomography in adults with blunt major trauma and suspected multiple injuries, as a vertex-to-toes scanogram then a scan from vertex to mid-thigh, without repositioning the patient
  • Do not use focused assessment with sonography for trauma before immediate computed tomography, and do not use it as a screening test to decide on scanning
  • Do not routinely use whole-body computed tomography in children under 16; use clinical judgement to limit it to the areas needing assessment
  • Perform chest decompression before imaging only where there is haemodynamic instability or severe respiratory compromise, by open thoracostomy followed by a chest drain

What does the anaesthetist hand over, and to whom?

The anaesthetist hands over a structured, documented account to the trauma team leader and then to theatre or critical care. NICE NG39 says one member of the trauma team should be designated to take contemporaneous notes and the team leader is responsible for checking they are complete.

GPAS chapter 16 says handovers for patients needing emergency trauma surgery should be structured to ensure continuity of care, with clear documentation of the care delivered and the future treatment plan. It also recommends a standardised method such as situation, background, assessment and recommendation.

Which traps catch candidates on the trauma call?

The traps at a trauma call are usually about order and ownership, not knowledge.

  • Running ABCDE strictly in sequence. GPAS chapter 16 says airway, breathing, circulation and cervical spine stabilisation run in parallel
  • Giving litres of crystalloid. NG39 says not to use crystalloids in hospital for a patient with active bleeding
  • Forgetting the 3 hour limit on tranexamic acid, or forgetting to give it at all
  • Taking an unstable patient to the scanner. NG39 limits imaging in patients not responding to volume resuscitation
  • Claiming to lead the trauma call as a CT1. The team leader is a defined role, and anaesthesia for emergency haemorrhage control is consultant led
  • Leaving out heat loss, analgesia and the family. NG39 covers all three, including intravenous morphine as first-line analgesia and ketamine in analgesic doses as second line

How this comes up at the CT1 anaesthetics interview

The trauma call appears in the clinical judgement station as a pre-alert you are asked to respond to, usually with the scenario worsening halfway through. The station lasts 15 minutes after 5 minutes of reading and is scored by two assessors out of 50.

  • Clinical judgement and decision-making: name the trauma call priorities in parallel, say the NICE numbers you are sure of, and state who you would call
  • Working under pressure: describe the failed intubation plan before it fails, and keep the structure when the blood pressure drops
  • Reflective practice: offer the debrief. GPAS chapter 16 asks for regular multidisciplinary in-situ simulation for major trauma, which is a natural thing to have reflected on

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