Background <p>Early deaths among severely injured children are mainly due to exsanguination and severe traumatic brain injury, some of which may be preventable with timely emergency interventions. However, data on potentially reversible causes of death and the role of advanced prehospital procedures in paediatric trauma are scarce. This study aims to assess post-mortem findings to identify cases where advanced emergency interventions could have been applicable in children.</p> Methods <p>This retrospective, single-centre study analysed forensic files of deceased children and adolescents (age &lt; 18 years) regarding the potential benefit of advanced emergency procedures (e.g. prehospital transfusion, thoracotomy and resuscitative endovascular ballon occlusion of the aorta [REBOA]). Three independent reviewers systematically assessed each case to determine whether a potentially reversible cause of death was present and if advanced emergency interventions might have been applicable.</p> Results <p>A total of 243 paediatric cases were included. The majority of deaths occurred prehospitally (91.6%). While the cause of death showed a significant association with age group (<i>p</i> = 0.01), severe traumatic brain injury (TBI) was present across all age groups without significant variation. Cardiopulmonary resuscitation was performed in 68.5% of cases, achieving return of spontaneous circulation only in 12.1%. Advanced emergency procedures were deemed feasible in only two cases (0.8%), including thoracotomy (<i>n</i> = 2), REBOA (<i>n</i> = 1), and prehospital transfusion (<i>n</i> = 2).</p> Conclusion <p>This study reveals age-dependent patterns in paediatric trauma mortality and a very limited but relevant potential for advanced interventions. A rare subset, adolescents without severe TBI, might have benefited. Findings support structured trauma systems, targeted training, and selected use of prehospital transfusion.</p> Trial registration <p>Not applicable.</p>