This updated European guideline on the management of bleeding and coagulopathy following major trauma provides evidence-based recommendations for the acute care of trauma patients. The guideline was developed by a multidisciplinary Task Force for Advanced Bleeding Care in Trauma, and represents an updated version of the 2007 and 2010 guidelines. The recommendations were formulated using a nominal group process, the GRADE hierarchy of evidence, and a systematic review of published literature. Key changes include new recommendations on the appropriate use of vasopressors and inotropic agents, and a discussion of thromboprophylactic strategies for all trauma patients. The guideline also emphasizes the need for institutions to develop and implement evidence-based clinical protocols for managing trauma patients. The recommendations have been re-evaluated and graded based on literature published since the last edition of the guideline, and changes in clinical practice have been considered. The guideline highlights the importance of early identification of bleeding sources and prompt measures to minimize blood loss, restore tissue perfusion, and achieve hemodynamic stability. It also discusses the pathophysiology of bleeding following traumatic injury, including the role of coagulopathy, which is a multifactorial condition influenced by environmental and therapeutic factors, as well as individual patient-related factors. The guideline provides recommendations for initial resuscitation, tourniquet use, ventilation, diagnosis and monitoring of bleeding, imaging, haematocrit, serum lactate and base deficit, coagulation monitoring, tissue oxygenation, fluid therapy, and hypothermia. It emphasizes the importance of early and aggressive fluid resuscitation, but also highlights the risks of excessive fluid administration, particularly in patients with severe head trauma or spinal injuries. The guideline also discusses the use of viscoelastic methods for coagulation monitoring and the importance of point-of-care testing for assessing coagulation status. It recommends the use of specific diagnostic modalities, such as ultrasonography and CT scans, for detecting free fluid in trauma patients. The guideline also emphasizes the importance of early surgical bleeding control in patients with haemorrhagic shock and an identified source of bleeding. Overall, the guideline aims to ensure a uniform and high standard of care across Europe and beyond by providing a comprehensive, multidisciplinary approach to trauma care and mechanisms to ensure that established protocols are consistently implemented.This updated European guideline on the management of bleeding and coagulopathy following major trauma provides evidence-based recommendations for the acute care of trauma patients. The guideline was developed by a multidisciplinary Task Force for Advanced Bleeding Care in Trauma, and represents an updated version of the 2007 and 2010 guidelines. The recommendations were formulated using a nominal group process, the GRADE hierarchy of evidence, and a systematic review of published literature. Key changes include new recommendations on the appropriate use of vasopressors and inotropic agents, and a discussion of thromboprophylactic strategies for all trauma patients. The guideline also emphasizes the need for institutions to develop and implement evidence-based clinical protocols for managing trauma patients. The recommendations have been re-evaluated and graded based on literature published since the last edition of the guideline, and changes in clinical practice have been considered. The guideline highlights the importance of early identification of bleeding sources and prompt measures to minimize blood loss, restore tissue perfusion, and achieve hemodynamic stability. It also discusses the pathophysiology of bleeding following traumatic injury, including the role of coagulopathy, which is a multifactorial condition influenced by environmental and therapeutic factors, as well as individual patient-related factors. The guideline provides recommendations for initial resuscitation, tourniquet use, ventilation, diagnosis and monitoring of bleeding, imaging, haematocrit, serum lactate and base deficit, coagulation monitoring, tissue oxygenation, fluid therapy, and hypothermia. It emphasizes the importance of early and aggressive fluid resuscitation, but also highlights the risks of excessive fluid administration, particularly in patients with severe head trauma or spinal injuries. The guideline also discusses the use of viscoelastic methods for coagulation monitoring and the importance of point-of-care testing for assessing coagulation status. It recommends the use of specific diagnostic modalities, such as ultrasonography and CT scans, for detecting free fluid in trauma patients. The guideline also emphasizes the importance of early surgical bleeding control in patients with haemorrhagic shock and an identified source of bleeding. Overall, the guideline aims to ensure a uniform and high standard of care across Europe and beyond by providing a comprehensive, multidisciplinary approach to trauma care and mechanisms to ensure that established protocols are consistently implemented.