Chinese expert consensus on the prehospital management of major trauma

To standardize the key techniques and protocols of prehospital emergency care for major trauma in China, and to improve the quality and efficiency of treatment, a multidisciplinary panel of experts in emergency medicine, trauma care, and prehospital rescue was organized to form an expert committee and a core working group. This initiative was co-sponsored by the Trauma Emergency and Multiple Trauma Group of the Trauma Society of the Chinese Medical Association, the Youth Group of the Disaster Medicine Society of the Chinese Medical Association, and the Combat and Trauma Care Specialty Alliance of Army Hospitals. The group systematically searched databases including PubMed, Embase, Cochrane Library, Web of Science, China Biology, Medicine, China National Knowledge Infrastructure, Wanfang Data, and VIP Information to collect relevant guidelines, systematic reviews, and clinical studies. Based on evidence-based findings and clinical practice scenarios, the consensus was drafted. Multiple rounds of consultation and voting were conducted, and a consensus meeting was held to resolve any disputed items. Ultimately, 16 recommendations were formulated addressing 14 core clinical questions in the prehospital management of severe trauma. The contents cover scene safety, rapid recognition and early warning of severe trauma, control of exsanguinating external hemorrhage (X), airway management (A), breathing management (B), circulation management (C), disability/neurologic assessment (D), exposure and temperature control (E), trauma in special populations (the elderly), immobilization and extrication, transport decision-making, prehospital-to-hospital handover, teamwork, and systematic training. This consensus strongly emphasizes the "xABCDE" assessment sequence and recommends key interventions such as the use of commercial tourniquets and wound packing for hemorrhage control, permissive hypotensive resuscitation, early administration of tranexamic acid, and the standardized application of pelvic binders. It also advocates the use of standardized communication models for prehospital-to-hospital handovers. This consensus provides prehospital emergency providers in China with a practical, evidence-based set of key techniques and protocols for severe trauma care, which will help promote the standardization of the prehospital trauma care system, support the development of a high-quality national prehospital trauma care system, and ultimately improve patient outcomes.