What are the key differences in management protocols for major haemorrhage in trauma versus non-trauma patients?

Key differences in management protocols for major haemorrhage in trauma patients compared to non-trauma patients include:

• Anticoagulant reversal: In trauma patients with major haemorrhage, rapid reversal of anticoagulation is critical, especially for vitamin K antagonists where prothrombin complex concentrate is used immediately; plasma is not recommended for reversal in trauma patients, unlike some non-trauma protocols where plasma may be used ¹.
• Activation of major haemorrhage protocols: Trauma protocols rely on physiological criteria including haemodynamic status and response to volume resuscitation rather than a single time-point haemorrhagic risk tool, which may differ from non-trauma settings ¹.
• Circulatory access: Trauma patients prioritize peripheral intravenous access or intra-osseous access if peripheral access fails, both pre-hospital and in-hospital; this may be more aggressively pursued in trauma due to urgency ¹.
• Volume resuscitation: Trauma management uses a restrictive volume resuscitation approach until bleeding control is achieved, with titration to maintain palpable central pulses pre-hospital and central circulation in hospital; in contrast, non-trauma protocols may allow less restrictive fluid replacement depending on the cause of bleeding ¹.
• Fluid replacement: In trauma, crystalloids are only used pre-hospital if blood components are unavailable, and are avoided in hospital settings; blood components are given in fixed ratios (1:1 plasma to red cells in adults), whereas non-trauma bleeding may have different fluid resuscitation strategies ¹.
• Use of tranexamic acid: Early intravenous tranexamic acid is recommended in trauma patients with active or suspected bleeding, ideally within 3 hours of injury; this timing and indication may differ in non-trauma haemorrhage ¹.
• Imaging: Trauma protocols emphasize urgent imaging with whole-body CT in blunt trauma and limit diagnostic imaging to what directs intervention in unstable patients, whereas non-trauma bleeding may rely on different imaging strategies ¹.
• Haemorrhage control: Trauma management includes specific interventions such as tourniquets for limb trauma, pelvic binders for pelvic fractures, and open thoracostomy for tension pneumothorax, which are trauma-specific and not applicable in non-trauma haemorrhage ¹.

Overall, trauma haemorrhage protocols are tailored to rapid identification, restrictive fluid resuscitation, early blood component therapy, and trauma-specific interventions, whereas non-trauma major haemorrhage management may have more variable approaches depending on bleeding source and patient condition ¹,².