National Audit Office data indicate that major trauma kills 5400 people in England annually, and it is the commonest cause of death in those under 40 years. The advanced trauma life support (ATLS) course (American College of Surgeons 2008) provides a basic framework onto which hospital specialists can build their individual skills. The ATLS course focuses on the initial management of patients with major injuries during the so-called ‘golden hour’. The golden hour reflects the importance of timely treatment. A severely injured patient who is hypoxic, in haemorrhagic shock, or who has an expanding intracranial haematoma, for example, will need rapid, effective resuscitation. The aim is to restore cellular oxygenation before the onset of irreversible shock.