Rapid Endovascular Hemorrhage Control in Trauma: Joint Position Statement from the American College of Surgeons Committee on Trauma and the Society of Interventional Radiology

SUMMARY: Timely hemorrhage control is a critical determinant of survival after traumatic injury, and advances in transarterial embolization have made rapid access to endovascular intervention an increasingly important component of contemporary trauma care. This joint position statement from the American College of Surgeons Committee on Trauma and the Society of Interventional Radiology clarifies expectations for interventional radiology under ACS Verification, Review, and Consultation Program Standard 4.15 and provides practical guidance for integrating endovascular hemorrhage control into trauma centers. Standard 4.15 reflects a requirement for system readiness rather than a universal mandate that every vascular intervention begin within 60 minutes. Rapid intervention is expected when clinically indicated, particularly for patients with an endovascular target who are hemodynamically labile, and the relevant performance interval is the time from a shared decision by trauma surgery and interventional radiology to proceed with intervention to arterial puncture. Trauma centers should establish multidisciplinary activation pathways that enable rapid mobilization of personnel and resources while preserving clinical judgment regarding patient selection and competing priorities. Recommended strategies include standardized activation protocols, process mapping, parallel rather than sequential workflows, early patient transport when appropriate, documentation of key time points, structured debriefing, and continuous performance monitoring. Interventional radiologists should be integrated as essential members of multidisciplinary trauma teams rather than engaged late as procedural consultants. Applying the 60-minute expectation according to clinical urgency and monitoring decision-to-puncture time focuses Standard 4.15 on its intended objectives: institutional readiness, timely definitive hemorrhage control in appropriately selected high-risk patients, and continuous performance improvement.