Recently published national guidelines and case series evidence supports a standardised management protocol for pre-hospital traumatic cardiac arrest (TCA) in adults due to penetrating trauma. However, the pathophysiology of pre-hospital TCA in children is different, as the mechanism is typically blunt trauma with concealed haemorrhage, and as such caution must be applied to direct extrapolation of adult guidelines in this situation. This talk will describe some recent paediatric TCA cases, review of the relevant evidence, and suggest a decision framework to support the pre-hospital team.