Multidisciplinary Management Pathways in Polytrauma: Integrating Prehospital Care, Emergency Resuscitation, and ICU Strategies
I Gde Made Satya Wangsa *
Orthopedic and Traumatology Department, Faculty of Medicine, Udayana University/Prof. Dr. I.G.N.G. Ngoerah General Hospital, Denpasar, Bali, Indonesia.
K.G. Mulyadi Ridia
Orthopedic and Traumatology Department, Faculty of Medicine, Udayana University/Prof. Dr. I.G.N.G. Ngoerah General Hospital, Denpasar, Bali, Indonesia.
*Author to whom correspondence should be addressed.
Abstract
Polytrauma remains a leading cause of preventable death and disability worldwide, with outcomes strongly shaped by how well prehospital services, emergency departments, operative/interventional teams, and intensive care units function as a single coordinated system. Modern trauma care is increasingly organised around time-sensitive pathways that prioritize hemorrhage control, avoidance of secondary injury, and rapid transitions to definitive care, while simultaneously recognising that overly aggressive interventions can worsen coagulopathy, hypothermia, acidosis, and inflammatory complications. This review synthesizes contemporary evidence and high-impact guidance on integrated polytrauma management across the continuum: (i) prehospital triage, hemorrhage control, airway/ventilation decisions, and early resuscitation including blood products and antifibrinolytics; (ii) emergency department trauma team workflows emphasizing parallel processing, damage control resuscitation, massive transfusion activation, and imaging strategies; (iii) early operative and interventional hemorrhage control, including selective use of endovascular temporizing measures; and (iv) ICU strategies that prevent secondary brain and organ injury, reduce nosocomial harm, and enable earlier rehabilitation. A targeted literature search was conducted across PubMed/MEDLINE, Embase, Cochrane Library, Web of Science, and Scopus (January 2015 - November 2025) to identify high-impact evidence on multidisciplinary polytrauma pathways. We emphasise practical decision nodes and handoff interfaces—where delays, miscommunication, or mismatched priorities commonly occur—and propose a pathway-based framework that links physiology-driven resuscitation, definitive haemorrhage control, and staged surgical repair. Key themes include early recognition of life-threatening bleeding, individualised hemostatic resuscitation guided by evolving evidence, structured timing of major fracture care in the context of concomitant injuries, and ICU bundles for venous thromboembolism prevention, neuroprotection, and organ support. Finally, we outline implementation approaches (protocols, simulation, registries, and quality metrics) and future directions, including precision resuscitation, refined prehospital blood strategies, and integrated hybrid trauma platforms.
Keywords: Polytrauma, prehospital care, damage control resuscitation, massive transfusion, tranexamic acid, REBOA, ICU trauma, traumatic brain injury, venous thromboembolism prophylaxis