Technology in Trauma Episode 1: Resuscitation and rescue at the edge

In the resuscitation room, we fight the lethal triad of hypothermia, acidosis and coagulopathy ¹. In an extreme environment, the patient frequently arrives already deep inside this triad, because the cold and the clock have done their work before anyone laid hands on the patient. Could technology help us fight against this clock? Technology in trauma management carries two distinct jobs: reaching the casualty, and sustaining resuscitation far from a hospital until the haven is reached.

Reaching the casualty

The headline tools are familiar. Search and rescue helicopters with hoists and thermal imaging, run in the UK by HM Coastguard and supported by mountain rescue teams across Scotland, Wales and the Lake District, remain the backbone of remote extraction. What has changed is everything around them. Time spent simply finding the patients are now revolutionarily compressed with novel location-sharing networks, including what3words and satellite messengers that work beyond mobile coverage ^2,3.

Uncrewed aircraft are the genuinely new entrant. The strongest evidence so far comes from Sweden, where autonomous drones fly automated external defibrillators that can reach suspected cardiac arrests before the ambulance in roughly two thirds of cases, with a median time saving of around three minutes ⁴. UK teams have since run beyond-visual-line-of-sight trials of the same idea. The same principle could naturally extend to trauma: tourniquets, haemostatic dressings and communications relays can be delivered to a casualty before a rescuer can physically arrive.

However, it must be mentioned that there is an honest caveat buried in those same studies, and it matters more in our setting than anywhere else. The Swedish drones did not fly in darkness, in poor weather, or without air traffic approval. Those are precisely the conditions of the Scottish Highlands in a winter whiteout or the Cornish coast in a storm. The tool is at its most fragile in the environment that most needs it, however, provides us with an invaluable backbone to work with.

How we rescue also turns out to be a clinical act, not just a logistical one. Work from the Extreme Environments Laboratory at Portsmouth describes circum-rescue collapse, in which a substantial proportion of immersion deaths occur in the minutes just before, during or immediately after removal from the water due to cardiac arrest that can be caused inevitably with sudden vertical lifting and rough handling of an already cold and hypovolaemic patient ⁵. This is where the guidelines rather than instinct ensure safety, where clinical decisions backed up by research could save lives even in the adrenaline cloud of extreme rescue environments.

Resuscitating at distance

Once reached, the patient may need resuscitation that runs for hours, not the minutes that the golden-hour model assumes. The key task is to carry damage-control resuscitation forward to the casualty. With this, haemorrhage control comes first: tourniquets, junctional devices and haemostatic dressings are now standard in remote and wilderness kit^6,7. Following this, forward-carried blood and freeze-dried plasma let transfusion start at the scene rather than at the hospital door ^8,9. This matters because every hour of uncontrolled bleeding and dilution deepens the trauma-induced coagulopathy we later reverse in theatre and the environment can definitely make this worse. Cold and acidosis is what completes the lethal triad, so insulation, vapour-barrier wrapping and warmed fluids are not comfort measures but part of protecting the clot.

Technology increasingly lets resuscitation be both sustained and informed. Handheld ultrasound and point-of-care analysers for lactate, haemoglobin and coagulation bring a fragment of the resus room to the scene, and satellite links let a distant surgeon or trauma team see that picture and guide decisions from hundreds of miles away.

The British story

The Defence Medical Services, through prolonged field care developed in recent conflicts, have driven many of the forward resuscitation techniques now reaching civilian remote and rural practice. Much of that forward practice now reaches patients wherever they fall, from London’s Air Ambulance serving one of the busiest cities in the world to Scotland’s retrieval services covering some of the most isolated terrain in Europe.

Behind the clinical practice sits invaluable research in extreme environment physiology. The Extreme Environments Laboratory at Portsmouth also established that cold shock, rather than hypothermia, kills most people who drown in cold water, and turned that into practical guidance on how long rescuers should keep searching for a submerged casualty ^5,10. UCL’s altitude and extreme environment medicine group took the same approach to hypoxia, sampling arterial blood high on Everest to understand how critically ill patients tolerate low oxygen delivery ¹¹. It is this translation from expedition to the resus room that guides our clinical practice.

That gap between promise and proof is the theme this column will return to. Trauma care has never been short of new technology, and the specialty has a long record of adopting innovation quickly once they earn their place. The questions worth asking of each piece we will discuss here are simple enough: what does it change for the patient in front of us, and what evidence would we need before it changes our practice. These are the questions this column will seek to answer, and in doing so carry promise into practice, and practice into survival.                                                                                                                       

By Dr. Zekiye Karagozlu

References

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3. Arthur R. A critical analysis of the What3Words geocoding algorithm. PLoS One. 2023 Oct 25;18(10):e0292491. doi: 10.1371/journal.pone.0292491.
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8. Yliharju H, Jama T, Nordquist H. Initial experiences of prehospital blood product transfusions between 2016 and 2020 in Päijät-Häme hospital district, Finland. Scand J Trauma Resusc Emerg Med. 2022 Jun 6;30(1):39. doi: 10.1186/s13049-022-01027-z.
9. Kodakadath H, Dillane S, Griggs J, Greenhalgh R, Clarke S, Tucker H; Air Ambulance Charity Kent Surrey Sussex. Pre-hospital blood transfusion in non-traumatic major haemorrhage: a retrospective observational study. Scand J Trauma Resusc Emerg Med. 2025 Nov 28;33(1):191. doi: 10.1186/s13049-025-01495-z.
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