Trauma-related injuries are the second leading cause of death and disability in South Africa. The traditional approach to surgery and resuscitation of severely injured patients has undergone change over the past 10 years. New concepts like damage control surgery and damage control resuscitation radically changed the practice of conventional resuscitation. Bleeding trauma patients die as a consequence of the so-called lethal triad or bloody vicious cycle: acidosis, coagulopathy and hypothermia. Effective initial management of trauma patients can help to improve outcomes.

Keywords: massive blood transfusion protocol, damage control surgery, damage control resuscitation, hypothermia, coagulopathy, metabolic acidosis, massive bleeding