There were 56 deaths following trauma in the adult Accident and Emergency Department of the University Hospital, Nottingham, over a 5-year period from 1983 to 1987. Forty-six of these deaths followed road-traffic accidents. The trauma deaths made up 16% of all adult deaths and 0.13 per thousand new attenders. We found evidence of inappropriate management in four cases, all relating to inadequate volume replacement. In two patients, the degree of hypovolaemia was not appreciated and in the other two, volume replacement was not commenced within 30 min of arrival in the department. Prompt treatment of hypovolaemic shock with appropriate fluids in adequate quantities cannot be overemphasized.
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