Effective prehospital management can significantly impact outcomes in patients with multiple and severe injuries.

• Begin fluid replacement in severely injured patients, limiting it in those with uncontrolled bleeding (MAP of 65 mmHg, SBP of 80 mmHg) to minimize blood loss.
• For hypotensive patients with potential traumatic brain injury, maintain normal blood pressure (MAP of 85 mmHg, SBP of 110 mmHg).

Administer tranexamic acid (1 g) for hemorrhagic shock; consider fibrinogen for uncontrollable bleeding.

• Utilize intraosseous access when intravenous access fails.