Activating Code Crimson in the emergency department: Expediting definitive care for trauma patients with severe haemorrhage in Singapore

"Trauma activation" is a process adopted across all emergency departments of public healthcare institutions in Singapore, with the aim of rapidly mobilising personnel and resources to care for patients with major trauma. A subset of trauma patients with exsanguinating haemorrhage has a particularly high mortality rate, and they require an additional response beyond the usual trauma activation for definitive haemorrhage control. To address this need, Code Crimson has been developed at Auckland City Hospital in New Zealand and other jurisdictions as a step-up response. This is aimed at early activation of the massive transfusion protocol for haemostatic resuscitation, involvement of additional multidisciplinary teams for rapid decision-making, and expediting definitive haemorrhage control. At present, there is no protocol for activation of Code Crimson in Singapore. Code Crimson may be effective in Singapore, as it has been in other jurisdictions, to reduce morbidity and mortality in major trauma patients with severe haemorrhage.