ABC has become established as the ubiquitous emergency care paradigm, reflected across the spectrum of advanced life support programmes. Military practitioners have been intuitively uncomfortable with this, as experience and evidence indicate that external peripheral haemorrhage is the leading cause of combat casualty death. In the UK military, ABC has now been replaced by <C>ABC, where <C> stands for catastrophic haemorrhage. The rationale for this change is explained in this commentary, together with its relevance to civilian practice.

Military ballistic injury is different from civilian blunt trauma. The nature of ballistic injury varies according to the type of weapon system causing the injury, the type of ballistic protection worn by the casualty and the nature of the conflict (urban, maritime or jungle). Although some injuries are inevitably unsurvivable, death may be avoidable in many cases, with rapid and decisive care at the point of wounding.

Champion et al¹ have estimated that 10% of all battlefield deaths are caused by haemorrhage from extremity wounds. On analysis of …