For the critically injured, life's blood ebbs away with every passing minute. It is a sad reflection that there have probably been more brains maimed by lack of oxygen than as a result of injured neuronal tissues. Management priorities must be dictated by the need to restore pulmonary and cardiac function rapidly, with the aim of producing an adequate supply of oxygenated blood to the cerebral cortex and other vital organs. Thereafter the patient must be made ready for surgery without delay. So often the battle is won or lost in the first precious minutes in the A & E department. Responsibility for resuscitation should not be left solely to junior staff, as there can be no substitute for experience in this demanding branch of medicine. Expert anaesthetic help must always be readily available and casualty staff must be encouraged to summon it without delay.