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Improving trauma care for critically bleeding patients: A national best-practice critical bleeding bundle of care with...

13 Dec 2021

This document is a practical guide for clinical staff to use to inform their care of critically haemorrhaging trauma patients.

It is also intended to inform clinical governance discussions. Ideally, if existing processes and approaches do not match this guidance, the latter will be used to inform a change process that adjusts pathways so critically haemorrhaging trauma patients receive the  best and most timely care possible (within the constraints of the local context, capacity and capability).

It is the key deliverable from the critical haemorrhage project, which is a partnership between the National Trauma Network, the Accident Compensation Corporation, the Health Quality & Safety Commission, the New Zealand Blood Service, the Australian and New Zealand Massive Transfusion Registry, ambulance services and district health boards, specifically emergency departments, perioperative teams and intensive care units. 

  • The project aim is to reduce mortality and complications in critically haemorrhaging trauma patients. The overall project aim is to eliminate avoidable deaths from haemorrhage and multiple organ failure in trauma patients by 2025.
  • The aspirational goal is to achieve zero in-hospital deaths from haemorrhage following trauma.

The development of this guide has been informed by two expert reference groups, to whom the Commission and Network are very grateful for their time and expertise.

Our earlier publication, Improving trauma care for critically bleeding patients: A history, evidence summary and proposed quality improvement approach, provides the background and evidence for the development of this document.

For any enquiries, please email:

File formats for providers
  • We have provided the complete guide below, in print and web PDF formats, as well as specific sections and content as standalone PDFs.
  • We have also provided the diagrams and cue cards from the guide as an Adobe InDesign file (zipped folder), if providers wish to edit and adapt them, which they are free to do.
  • PDFs may also be edited if providers have Adobe Acrobat Pro software, but please note that if editing and adapting the PDF content, the Network and Commission logos need to be removed. 
  • We would appreciate the Network and Commission being acknowledged as the source of the original content, if any adaptations are made. Thank you for your cooperation in this.  
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

Published: 13 Dec 2021 Modified: 13 Dec 2021