Resources must be optimised for the many, rather than dispersed for the few

War injures and kills combatants and civilians. Medical resources are usually scarce in combat zones, and doctors must plan to make the most of these resources to minimise death and suffering. Planners seek to apply the widely adopted principles of advanced trauma life support to the treatment of penetrating wounds, burns, and other forms of acute physical trauma on the battlefield. This recognises the critical importance of effective early resuscitation after wounding to minimise the consequences of shock and to improve survival.

Mortality after civilian trauma has been described as having a trimodal distribution.1 The first peak of deaths occurs within minutes of the event from non-survivable injuries, even with the most advanced medical resources immediately to hand. The second peak may account for some 30% of deaths, in the first few hours after injury. Death is most often due to hypoxia and hypovolaemic shock.2 This group stands to benefit the most from excellence in trauma care. The third peak, of up to 20% of trauma deaths, occurs late after the injury, from sepsis, multi-organ failure, and other complications.

Does this descriptive …