The Code Red Protocol: Revolutionising the Treatment of Knife Wounds

Over the course of the last decade, deaths caused by severe bleeding from major trauma have been reduced by more than forty per cent. This is thanks to a revolutionising approach to the treatment of major trauma, such as knife wounds. Pioneered through a collaborative effort between Queen Mary University of London, Barts Health NHS Trust and NHS Blood and Transport, the approach has been named “Code Red.” Doctors, who have been working on the approach since 2003, now emphatically declare that the chances of surviving a major bleed are now higher than ever before. The revolutionary approach turns the science behind treating catastrophic bleeds on its head.

Prior to the development of the Code Red protocol, the approach to dealing with major trauma injuries such as knife wounds was marked by replacing lost fluids. Saline solution mixed with oxygen was pumped into the body as part of a massive transfusion. Previously, the aim was to maintain the body’s oxygen supply, yet this was damaging to the body’s natural mechanism of stemming bleeding, which is clotting.

By flooding the body with saline, the patient’s blood would become diluted and therefore harder to clot. More than a decade ago, the Royal London Hospital introduced the Code Red approach, also known as damage control resuscitation.

Traumatic injury remains the leading cause of death for people under 45. With incidents such as the Manchester Arena bomb attack and a growing knife crime epidemic, traumatic injury remains firmly in the public conscious. The surge in knife attacks over the last decade has also increased the profile of trauma services in hospitals. However, with the Code Red protocol and rapidly advancing scientific progress in trauma treatment, doctors are reversing longstanding historical trends. In 2008, 48% of critically bleeding major trauma patients died in hospital. By 2017, that figure was reduced to 27%.