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Scoping work

Initial scoping work was undertaken to understand the history and current state of critical haemorrhage in Aotearoa New Zealand and to gather evidence to guide the direction of quality improvement work. This work is summarised in the Improving trauma care for critically bleeding patients: A history, evidence summary and proposed quality improvement approach document and accompanied by the case for change infographic.

Project plan

An expert reference group comprising clinicians, consumers, Māori and quality improvement representatives was formed and determined that the ‘bundle of care’ concept was the most appropriate to achieve the goals of this project. Care bundles are sets of evidence-based practices delivered consistently across health care systems to improve patient outcomes and were introduced by the Institute for Healthcare Improvement as a method to reduce variation in care [1]. The trauma programme project plan: critical haemorrhage sets out the aim, rationale, objectives and approach for the critical haemorrhage project agreed upon by Te Tāhū Hauora, the Network, ACC and the expert reference group.

Bundle and guidance

In December 2020, Te Tāhū Hauora and the Network published Improving trauma care for critically bleeding patients: A national best-practice critical bleeding bundle of care with associated guidance and massive transfusion protocol.

The document is a practical guide for clinical staff to inform their care of critically haemorrhaging trauma patients. It is the key deliverable from the critical haemorrhage project and has been informed by experts from across the health sector. Te Tāhū Hauora and the Network are very grateful for their time and expertise.

Associated downloads

A4 guide printable PDF (web version, no crop marks) PDF (739KB)
A4 guide for professional printing (crop marks and bleed) PDF (751KB)
A4 PDF of timeline of the accelerated treatment pathway on activating Code Crimson PDF (317KB)
A3 PDF of timeline of the accelerated treatment pathway on activating Code Crimson PDF (134KB)
A4 PDF of Code Crimson Massive Transfusion Protocol  PDF (296KB)
A3 PDF of Code Crimson Massive Transfusion Protocol PDF (84KB)
A4 PDF of Paediatric Massive Transfusion Protocol PDF (267KB)
A3 PDF of Paediatric Massive Transfusion Protocol PDF (84KB)
A4 PDF set of cue cards defining the roles and functions for key members of the trauma team PDF (1.1MB)
InDesign file of all diagrams and cue cards from the guide IDML (1.1MB) zipped


[1] Resar R, Griffin FA, Haraden C, et al. 2012. Using Care Bundles to Improve Health Care Quality. IHI Innovation Series white paper. Cambridge, MA: IHI. URL:

Published: 3 Aug 2023 Modified: 8 Aug 2023