You call the surgeon and anaesthetist and tell the operating suite to get the emergency theatre ready. The surgeon agrees with your plan and you both whisk the patient upstairs

At operation you find around 700mls of blood in the abdomen and a grade 3 injury to the spleen, probably caused by one of the lower ribs at the moment of impact. The spleen is repaired and with further resuscitation the boy's condition stabilises.

After a CT scan which shows only a mild diffuse brain injury he is taken to the intensive therapy unit for warming and correction of his acidosis and coagulopathy prior to further investigation and therapy.