The Advanced Trauma Life Support (ATLS) guidelines apply in the case of the multiply injured patient.
Injuries that threaten the airway or cardiopulmonary systems take priority.
In the multiply injured patient, it may be necessary to do a "simpler" "damage-control spinal operation". A posterior open reduction internal fixation is the option of choice. If anterior decompression is required, this can be done in a delayed fashion when the patient is stabilized.
The coordination of the management of the multiply injured patient needs to be protocoled in association with other members of the trauma team.
It is essential to minimize blood loss and length of surgery in the multiply injured patient.
Patients with a traumatic spinal cord injury should have surgical intervention within the first 24 h of injury.
Patients without a spinal cord injury should have surgical intervention within 72 h of the trauma.