Background <p>Trauma, particularly injuries involving massive bleeding, is a leading cause of preventable death worldwide. Prehospital setting plays a critical role, with bleeding control being a primary focus. While guidelines like the European and German Bleeding Guidelines provide evidence-based recommendations for bleeding management, the extent to which these guidelines are implemented by emergency physicians in the prehospital setting remains unclear.</p> Methods <p>A nationwide online survey was conducted in Austria to assess emergency physicians’ familiarity with and implementation of the European and German Bleeding Guidelines on bleeding control in prehospital settings. The survey was distributed through emergency medical organizations in Austria, gathering 116 responses.</p> Results <p>Despite high awareness of the Bleeding Guidelines (81%), only 41% of new recommendations were implemented. Moreover, only 50% adhere to recommendations that were already included in previous versions. A questionnaire assessing knowledge about the Bleeding Guidelines’ content revealed a mean score of 13.5 ± 4.37 (maximum score of 26 points), indicating a gap in knowledge application.</p> Conclusions <p>This study highlights the potential for improving the implementation of trauma and bleeding management Guidelines in the prehospital setting. The findings indicate that, despite a strong awareness of the Bleeding Guidelines, a gap exists between knowledge and practical application. This gap underscores the need for enhanced training, regular continuing education, and the use of algorithms and checklists to support Bleeding Guideline adherence. Further studies are needed to explore the reasons for this non-adherence, and additional qualitative research in this field is essential.</p>