<p>Trauma remains one of the leading causes of death worldwide, particularly among young adults. Despite improvements in structured trauma systems and hospital-based interventions, a substantial proportion of preventable deaths still occur in the prehospital phase, often within minutes and well before emergency medical services (EMS) intervention. Among the most critical and potentially reversible contributors to early mortality is apnoea, which can rapidly lead to hypoxic injury and death. This narrative review aims to explore the pathophysiology, epidemiology, and recognition of early post-traumatic apnoea, with a focus on dispatcher-assisted interventions during the initial minutes following trauma. Autopsy studies and trauma registries suggest that 18–43% of pre-EMS trauma fatalities involve potentially reversible apnoea. Notably, impact brain apnoea—a neurogenic cessation of breathing following blunt head trauma—and airway obstruction can frequently occur, and their identification by untrained callers is unreliable. Nevertheless, structured dispatcher questioning combined with live video technology may substantially enhance detection rates. Dispatcher-guided basic airway management, such as the jaw thrust or chin lift, has been shown in simulation settings to restore breathing in up to 60% of cases. The lateral trauma position, when executed with cervical spine considerations, offers a practical means to maintain airway patency with no greater spinal motion than that caused by a traditional log roll. Conversely, evidence supporting mouth-to-mask ventilation by laypersons remains limited, and concerns over infection continue to affect its effective uptake. Overall, early apnoea after trauma remains a great risk for survival, while bystanders represent an underestimated resource. Equipping dispatchers with standardized, evidence-based protocols—supported by new tools like live video—may offer a cost-effective approach to improving survival during the most vulnerable critical minutes after the injury.</p>