These patient are only rarely salvageable. The second peak occurs minutes to hours after the injury. Death is due to subdural or epidural hematoma, hemopneumothorax, spleen or liver injury, and unstable pelvis fracture. This is the 'golden hour' of trauma care when timely and appropriate interventions can improve survival. These results are better than most civilian centers.
Third peak occurs days to weeks post injury.
Treat the greatest threat to life first. The lack of a definitive diagnosis should not delay treatment, and a definitive history is not essential. Assume that there are multiple injuries, and that the obvious injury is not necessarily the most important. Ensure adequate airway, breathing, and circulation as the first priorities. Assess for airway obstruction, facial fractures, foreign bodies, and tracheal injuries.