The American College of Surgeons (ACS) committee on trauma and the Society of Interventional Radiology (SIR) have issued a joint position statement positioning the role of interventional radiologists on multidisciplinary trauma teams and the importance of establishing reliable systems for rapid endovascular haemorrhage control in trauma situations.
The joint-position statement, ‘Rapid Endovascular Hemorrhage Control in Trauma’, outlines how trauma programmes can expedite access to haemorrhage-stopping embolization through earlier consultation, shared decision-making and coordinated activation of the full care team.
“For a patient in haemorrhagic shock, every step between recognising the bleeding and achieving definitive control matters,” said Luke R Wilkins, the statement’s lead author and an interventional radiologist at the University of Virginia Health System in Charlottesville, USA. “Trauma centres need processes that bring trauma surgeons and interventional radiologists together early, mobilise the full team in parallel and get the right patient to treatment without avoidable delay.”
“This statement reinforces that the fastest path to haemorrhage control begins with early communication and a shared plan,” said Jon Perlstein, chair of trauma and acute care surgery at Sutter Health/Sutter Roseville Medical Center in Roseville, USA and a co-author of the statement. “By integrating interventional radiology [IR] into trauma workflows from the outset, teams can match each patient with the most appropriate treatment, coordinate operative and endovascular care when both are needed, and reduce delays to definitive bleeding control.”
The statement clarifies the intent of ACS Standard 4.15, which requires Level-one and Level-two trauma centres to maintain the personnel and facilities needed to begin an endovascular or IR procedure for haemorrhage control within 60 minutes when the patient’s clinical condition requires rapid intervention. It also provided the following guidance for operationalising the standard:
- Engage IR early to support rapid, shared decisions about the most appropriate method of haemorrhage control.
- Prioritise patients most likely to benefit from rapid angioembolization, such as patients who are haemodynamically unstable or require transfusion.
- Create a standardised activation pathway that defines who initiates consultation, who can activate the pathway and how the angiography suite, anaesthesia, transport, nursing and technologist teams are mobilised.
- Establish protocols to support parallel workflows for patients who need both endovascular and operative interventions.
- Measure decision-to-puncture time, along with other milestones that reveal workflow bottlenecks.
- Use continuous performance improvement tools, such as multidisciplinary debriefings, process mapping, staff education and review of delays, to strengthen readiness and sustain reliable response times.
“This joint statement gives trauma centres a shared, practical framework for bringing surgical and endovascular expertise together when every minute matters,” said Saher S Sabri (MedStar Health and Georgetown’s School of Medicine, Washington, DC, USA), SIR president. “Aligning trauma teams around early collaboration, system readiness and continuous improvement can reduce avoidable delays and deliver the most appropriate lifesaving care for each injured patient.”
“Rapid haemorrhage control depends on a trauma system that is prepared to bring the right expertise and resources to the patient without delay,” said Avery Nathens (University of Toronto, Toronto, Canada) medical director of the ACS Trauma Quality Programs and senior author of the statement. “This joint statement translates that shared commitment into practical guidance that can strengthen collaboration, improve readiness and help trauma teams deliver timely, definitive care to patients with life-threatening bleeding.”
