The management of catastrophic bleeding is the first step in the primary assessment, because it can cause death even before an obstructed airway. Airway management and ventilation remain a priority. Permissive hypotension is increasingly accepted in the management of major trauma with hypovolemic shock except in the case of patients with head trauma. Prevention and control of the deadly triad (acidosis, hypoxia and hypothermia) improve the prognosis. An “excessive stabilization” approach should be avoided, so that access to definitive treatment is not delayed.