Intensive Care Medicine (or Critical Care, the terms are used interchangeably) is an evolving specialty both within the UK and worldwide. It has recently been established as a UK speciality in it’s own right, and is at the centre of the modern acute hospital, responsible for managing the sickest and most complex patients. There is a growing cadre of critical care specialists in the UK, underpinned by a large number of doctors in training within the specialty. Management of patients with severe traumatic injury is provided by intensive care specialists, often in conjunction with a range of other professionals such as surgeons and interventional radiologists. The management of these patients, who have competing complex injuries can be challenging. Traumatic injury is recognised as a significant cause of preventable mortality and such patients are now clustered within Major Trauma Centres across the UK. The Defence Medical Services of the UK have spent the last 10 years managing patients with very severe traumatic injuries, first in Iraq and most recently in Afghanistan. The lessons learnt from this experience has filtered through to the NHS, resulting in many changes to established practice. Whilst several books have been published based on this experience, none have focused on the intensive care management of such patients, which represents a vital link in the chain of survival from injury to recovery.