Abstract Aim Major trauma (MT) is a significant cause of morbidity and mortality in the United Kingdom, with an estimated incidence of 20,000 cases annually in England. A certain proportion of patients presenting following MT require immediate operative intervention. This study is a re-audit of the process for managing these patients in order to assess the impact of introduction of a Damage Control Surgery (DCS) pathway. Methods Data were reviewed for all patients presenting as Code Red MT and requiring immediate operative intervention from May to November 2023. This accounts for all patients since the implementation of the DCS pathway. Patient details were taken from a MT database, Electronic Care Records were used to determine aetiologies of trauma and outcomes, and Theatre Management System software was used to determine timings. Results 9 patients were identified, with a median age of 30.33. 89% of patients underwent preoperative CT imaging, with an average time to CT of 15 minutes (range 5 to 57 minutes). Median time to theatre was 88 minutes (range 39 to 325 minutes). Specialties involved included General Surgery, Vascular, Cardiothoracics and Trauma and Orthopaedics, with multispecialty involvement in some cases. Overall mortality was 22%. Seven cases were the result of road traffic collisions. Conclusions MT remains a significant cause of mortality in our cohort, but implementation of a DCS pathway has led to significant improvements in both time to CT and time to theatre compared with our initial audit cycle (32 minutes/144.5 minutes).