Section F Resuscitation and Trauma Life Support (iaw current BATLS, PHEC principles)

Nov 18, 2025
7 min read

Index

Catastrophic Haemorrhage Control: Tourniquets and Haemostatic Dressings
Structured Assessment: Primary and Secondary Surveys
Airway Management and Ventilatory Support
Chest Emergencies: Needle Decompression and Needle Thoracentesis
Circulation, Vascular Access and Intravenous Therapy
Intraosseous Access: EZ-IO and FAST1 in Shock and Arrest
Managing Time-Critical Medical Emergencies: Cardiac Events, Sepsis and Overdose
Neurological Assessment, Deterioration and Seizure Management
Prolonged Casualty Care Afloat and Safe Extraction
CASEVAC/MEDEVAC and Caring for the Casualty in Transit
Pelvic Splintage and Major Trauma Stabilisation
Key Reflections and Practical Takeaways

Introduction

In high-threat, resource-limited environments – whether on operations, at sea, or in remote locations – clinicians must combine technical excellence with calm, structured decision-making. The notes in this piece come from frontline Royal Navy combat medical practice and map closely onto the realities faced by pre-hospital, shipboard and expeditionary clinicians.

At Kraken Medical, we translate this experience into robust training and clinical support. This article distils a wide range of competencies – from catastrophic haemorrhage control and airway interventions to sepsis recognition, overdose management and prolonged care afloat – into a structured, clinically focused overview.

1. Catastrophic Haemorrhage Control: Tourniquets and Haemostatic Dressings

Catastrophic haemorrhage remains one of the most preventable causes of death in trauma. A C–ABCDE mindset (Catastrophic haemorrhage first, then Airway, Breathing, Circulation, Disability, Exposure) underpins modern practice.

Tourniquets

Applied proximal to the bleeding site and tightened until haemorrhage stops.
Placement must balance effectiveness with minimising damage to nerves and soft tissue.
Regular reassessment is essential to identify ongoing bleeding, limb threat, or the need for conversion when appropriate and safe.

Haemostatic dressings

Packed directly onto the bleeding source to support rapid clot formation.
Most effective when combined with firm, sustained pressure and correct anatomical placement.
Particularly valuable in junctional areas (groin, axilla, neck) where tourniquets are not feasible.

Clinical reflection:Effective catastrophic haemorrhage control is less about “having the kit” and more about the speed, confidence and teamwork with which it is applied.

2. Structured Assessment: Primary and Secondary Surveys

A systematic approach prevents missed injuries and supports safe prioritisation.

Primary Survey (ABCDE)

Airway: Clear and maintain the airway, using simple manoeuvres (head tilt–chin lift, jaw thrust) and adjuncts where needed.
Breathing: Assess rate, effort, symmetry, chest movement and auscultation. Provide ventilatory support if inadequate.
Circulation: Check pulse, skin appearance, capillary refill and obvious haemorrhage. Begin CPR if indicated and control bleeding aggressively.
Disability: Rapid neurological assessment using AVPU or GCS to detect early deterioration.
Exposure/Environment: Fully expose the patient to assess for injury, while protecting from hypothermia and maintaining dignity.

Secondary Survey

Once life-threatening problems are addressed:

Head-to-toe examination: Systematic inspection, palpation and assessment of all regions.
History: Clarify events, past medical history, medications and allergies.
Vital signs and monitoring: Trend analysis rather than single readings.
Investigations: Imaging and laboratory tests where available.
Pain management: Timely, appropriate analgesia improves cooperation and overall outcomes.

Practical takeaway:

A well-executed Primary and Secondary Survey provides a shared mental model for the entire team and underpins safe handovers.

3. Airway Management and Ventilatory Support

Airway adjuncts and manual techniques

Jaw thrust: Preferred where cervical spine injury is suspected.
Oropharyngeal (OPA) and nasopharyngeal (NPA) airways: Maintain patency, particularly in patients with reduced consciousness. Proper sizing and gentle insertion prevent trauma.
Supraglottic devices (iGel): Offer a secure airway and effective ventilation when intubation is not possible or appropriate.

C-spine precautions must be integrated into airway management, using manual in-line stabilisation and collars where indicated.

Clearing the airway: suction and positioning

Postural drainage: Using gravity to help clear secretions or blood in patients with impaired cough.
Portable suction: Rapid removal of blood, vomit and secretions from the oropharynx to prevent aspiration and obstruction.

Careful monitoring during and after airway interventions is vital to detect hypoxia, arrhythmias or worsening obstruction.

Ventilatory support

Mouth-to-mouth / mouth-to-nose: Immediate, low-tech interventions to maintain oxygenation.
Laerdal pocket mask: Adds a barrier and improves seal.
Bag-valve-mask (BVM): Enables controlled positive-pressure ventilation, but requires good technique, appropriate rate and careful attention to chest rise and airway patency.

4. Chest Emergencies: Needle Decompression and Needle Thoracentesis

Needle decompression (tension pneumothorax)

Used in life-threatening tension pneumothorax with respiratory distress, reduced breath sounds, possible tracheal shift and cardiovascular compromise.
Insertion in the appropriate intercostal space using aseptic technique, followed by continuous monitoring and preparation for definitive chest drainage.

Needle thoracentesis (pleural effusion / pneumothorax relief)

Targeted procedure for diagnostic or therapeutic removal of pleural fluid or air.
Requires careful site selection, sterile preparation, slow controlled drainage and vigilant monitoring for complications (re-expansion pulmonary oedema, bleeding, pneumothorax).

Clinical reflection:

Both interventions demand clear indications, anatomical precision and continuous reassessment – they are not “one-and-done” procedures.

5. Circulation, Vascular Access and Intravenous Therapy

Minimal palpable blood pressure

Estimating haemodynamic status using pulses:

Carotid pulse: Suggests higher perfusion pressures than radial alone.
Femoral pulse: Useful in major trauma and low-output states.
Radial pulse: If absent, consider significant hypotension.

This is especially valuable in pre-hospital or austere settings where sphygmomanometers or monitors may not be immediately available.

Intravenous cannulation and fluid replacement

Competent cannulation includes:

Thoughtful site selection
Aseptic technique
Secure fixation
Confirmation of patency and proper flushing

Fluid therapy

Use crystalloids or other fluids according to indication, with careful monitoring of response, urine output and signs of overload.
In trauma and sepsis, fluids should be guided by clinical markers and evolving guidelines, not automatic “one-size-fits-all” boluses.

Complications of IV therapy

Key risks include:

Infiltration and extravasation
Phlebitis
Air embolism
Catheter-related bloodstream infection
Speed- or dose-related adverse effects
Allergic and anaphylactic reactions

Preventive strategies hinge on aseptic technique, secure connections, vigilant monitoring and prompt escalation when complications arise.

6. Intraosseous Access: EZ-IO and FAST

When IV access is difficult or impossible, intraosseous (IO) access provides rapid, reliable entry to the systemic circulation.

Key principles:

Site selection appropriate to age and condition (e.g. proximal tibia, humerus, sternal access with designated devices).
Strict asepsis and correct needle/device choice.
Confirmation of placement via stability and marrow/blood return.
Secure fixation and ongoing monitoring for compartment syndrome, extravasation or infection.

IO access is particularly valuable in shock, cardiac arrest and paediatric emergencies, where every second counts.

7. Managing Time-Critical Medical Emergencies

Cardiac events

A working knowledge of:

Shockable rhythms: Ventricular tachycardia (VT) and ventricular fibrillation (VF) – requiring high-quality CPR and early defibrillation.
Non-shockable rhythms: Pulseless electrical activity (PEA) and asystole – focusing on CPR, identification of reversible causes (5 Hs & 5 Ts) and appropriate pharmacological support.
Myocardial infarction / ACS: Rapid recognition, ECG acquisition, analgesia, antiplatelet therapy, nitrates as appropriate, and early referral for reperfusion.

Sepsis

Early identification through:

Abnormal temperature, tachycardia, tachypnoea
Hypotension, altered mental state
Evidence of organ dysfunction

Initial management centres on:

Early antibiotics
Fluid resuscitation
Vasopressors when required
Oxygen therapy
Source control and close monitoring

Poisoning and overdose

Key elements include:

ABC stabilisation as the first priority
Detailed history (substance, dose, timing)
Use of BNF and TOXBASE for evidence-based antidote and management guidance
Decontamination where indicated (e.g. activated charcoal within appropriate time window)
Specific antidotes such as naloxone for opioid toxicity
Ongoing monitoring and supportive care

8. Neurological Assessment, Deterioration and Seizure Management

AVPU and Glasgow Coma Scale (GCS)

AVPU offers a rapid screening of consciousness.
GCS provides a structured assessment of eye opening, verbal response and motor response, allowing trend monitoring and clearer communication between clinicians.

Monitoring neurological deterioration

Regular observations using tools such as a head injury chart (e.g. FMed 290 or equivalent).
Documentation of changes in consciousness, pupils, motor function and vital signs.
Clear escalation pathways and early involvement of senior or specialist clinicians.

Seizure management

Protect the patient from harm; do not restrain forcibly or insert objects into the mouth.
Time the seizure and observe characteristics.
Maintain airway and place in the recovery position when safe.
Recognise prolonged seizures or clusters as potential status epilepticus and treat as a medical emergency.
Provide reassurance and support during the postictal period and arrange appropriate follow-up.

9. Prolonged Casualty Care Afloat and Safe Extraction

Prolonged care (24–48 hours) afloat

Challenges at sea include limited resources, difficult evacuation and environmental constraints. Effective prolonged care requires:

Thorough initial assessment and triage
Stabilisation and pain control
Ongoing monitoring and documentation
Infection prevention and good hygiene practices
Maintenance of nutrition and hydration
Psychological support alongside physical care
Clear communication with remote medical support and planning for escalation or evacuation

Extraction from confined spaces, vehicles and aircraft

Safe extrication depends on:

Scene assessment and personal safety
Cervical spine and spinal precautions where indicated
Skilled use of lifting aids: extrication boards, Neil Robertson stretcher, Army pattern stretcher, Telford Extrication Device, etc.
Close team coordination to minimise movement and secondary injury.

10. CASEVAC/MEDEVAC and Caring for the Casualty in Transit

Documentation and communication

9-Liner MEDEVAC: Structured information to support rapid tasking and safe evacuation.
ATMIST handover: Concise transfer of clinical information (Allergies, Trends/Vitals, Medications, Interventions, Summary, past medical history).

Requirements in transit

Patient identification and clear labelling.
Safe securing on stretchers with attention to comfort and pressure areas.
Ready access to essential medicines, airway equipment and monitoring.
Ongoing reassessment and intervention during movement.
Adherence to infection control and regulatory standards across modes of transport (ground, air, sea).

11. Pelvic Splintage and Major Trauma Stabilisation

Pelvic fractures can be haemorrhage-producing and life-threatening.

Key principles:

High index of suspicion in high-energy mechanisms (falls, RTCs, blast).
Minimal movement and early application of a pelvic binder or improvised splint.
Binder positioned over the greater trochanters, not the waist.
Regular neurovascular checks of the lower limbs.
Monitoring for skin breakdown and discomfort under the device.

Pelvic splintage forms part of a broader damage-control approach, buying time for definitive imaging and surgical management.

12. Key Reflections and Practical Takeaways

Across these competencies, several themes stand out:

Structure saves lives: Whether it is ABCDE, AVPU/GCS, or the 9-liner format, structured approaches reduce error and improve team performance.
Early recognition, early action: From catastrophic haemorrhage and sepsis to cardiac arrest and overdose, delays cost lives.
Teamwork and communication: Effective handover (ATMIST), clear documentation and calm leadership are just as critical as technical skill.
Adaptability in austere settings: Prolonged care afloat, limited resources and difficult extractions demand creativity grounded in sound clinical reasoning.
Relentless reassessment: Every intervention – tourniquet, IO access, fluid bolus, thoracentesis – requires continual monitoring and willingness to adjust the plan.

Conclusion

The skill set described here reflects the realities of modern military and maritime medicine: high acuity, constrained resources, and the need to deliver hospital-level thinking far from hospital walls. At Kraken Medical, we draw on this experience to design training and support that are practical, evidence-informed and directly applicable to frontline practice.

Whether you are part of a ship’s medical team, a remote medic, or a hospital clinician seeking to sharpen your emergency and trauma skills, we are committed to helping you deliver safe, high-quality care in the most challenging environments.