Major trauma is a leading cause of death and disability worldwide and poses a significant socio-economic burden. Centralisation of trauma services and damage limitation measures; permissive hypotension, limited use of crystalloid fluids and balanced blood product transfusion, have significantly improved patient outcomes and remain the subject of much research. The initial management of trauma is guided by ATLS principles which provide a structured framework for all clinicians, regardless of their location. The urologist, working alongside a dedicated trauma team, may be involved in initial damage limitation measures such as the control of major haemorrhage or preventing gross urinary extravasation however definitive management of the urological injury is typically delayed until patient physiology has been stabilised.