Quality and adequacy of specialized first aid for patients affected by high energy trauma is extremely important factor in order to reduce postraumatic disability and mortality of polytrauma patients. Treatment strategies for high energy trauma management are in early stages of development. Adequate aid can be rendered only in a few centers of Lithuania. Pre-hospital and very early hospital stages of patients with high energy trauma, which significance is proven, are unsatisfactory and inadequate. A retrospective study was performed in order to analyze efficacy and adequacy of pre-hospital (Kaunas Emergency Station, KES) and very early hospital (Kaunas University of Medicine Hospital Emergency Room, ER) management stages for 53 patients affected by high energy trauma and admitted to Kaunas University of Medicine Hospital during the period of 2001-2002. Averaged injury severity score, according to ISS, was 21.3, mortality rate was 34%. It was established long duration of pre-hospital and early hospital stage of management (accordingly 34+/-6.5 and 50+/-17.2 minutes), extremely rare monitoring of vital signs in pre-hospital stage (breathing was evaluated for 1.9% of patients, heart rate for 26.4% of patients). Fluid therapy as a part of complex treatment was applied for 7.5% of patients in pre-hospital stage and 3.8% in very early hospital stage.