Table 1.

Primary and secondary outcomes

Outcome	Source of data	Mode of collection
Primary outcome
In-hospital mortality within 30 days of arrival at the emergency department	Patient hospital records. If the patient has been transferred to another hospital, the clinical research coordinators will collect data on this outcome by calling the patient or the patient’s representative, or by contacting the hospital to which the patient was transferred. Data on this outcome will be collected continuously during the trial	Main stepped-wedge design. Collected for all patients
Secondary outcome
All-cause mortality within 24 h, 30 days and 3 months after arrival at the emergency department	Patient hospital records or telephone follow up. If the patient has been transferred to another hospital or discharged, the clinical research coordinators will collect data on this outcome by calling the patient or a patient representative, or by contacting the hospital to which the patient was transferred. Data on this outcome will be collected continuously during the trial	Main stepped-wedge design. Collected for all patients
Length of emergency department stay	Data on this outcome will be collected from patient hospital records	Main stepped-wedge design. Collected for all patients
Length of hospital stay	Data on this outcome will be collected from patient hospital records	Main stepped-wedge design. Collected for all patients
Intensive care unit admission	Data on this outcome will be collected from patient hospital records	Main stepped-wedge design. Collected for all patients
Length of intensive care unit stay	Data on this outcome will be collected from patient hospital records	Main stepped-wedge design. Collected for all patients
Return to work at 30 days and 3 months after arrival at the emergency department	Data on this outcome will be collected in person if the patient is still in hospital, or by phone if the patient has been discharged	Main stepped-wedge design. Collected for all patients
Adherence to ATLS® principles during initial patient resuscitation, up to 1 h after the physician has first seen the patient	This assessment will be performed using a 14-item checklist covering the key steps of the ATLS® primary survey, based on previous work on ATLS® adherence [32]. We will consider completion of all 14 steps as 100% adherence. The clinical research coordinators will collect this data by observe the care being delivered to patients and will be trained by the trial team to do this, prior to the start of the trial	Nested staircase design. Collected for a random subset of patients
Quality of life within 7 days of discharge, and at 30 days and 3 months of arrival at the emergency department, measured by the official and validated translations of the EQ5D3L	Data on this outcome will be collected in person if the patient is still in hospital, or by phone if the patient has been discharged	Nested staircase design. Collected for all patients included during days with randomised shifts
Disability within 7 days of discharge, and at 30 days and three months of arrival at the emergency department, assessed using the WHO Disability Assessment Schedule 2.0 (WHODAS 2.0)	Data on this outcome will be collected in person if the patient is still in hospital, or by phone if the patient has been discharged	Nested staircase design. Collected for all patients included during days with randomised shifts