For optimum management of epistaxis, it is crucial that a clear ED management protocol [17] or epistaxis ladder [18] is developed in co-operation with the local Otolaryngology department.

Protocols should outline a staged process, where treatment of a patient with epistaxis starts with the simplest and least invasive techniques, moves through more advanced procedures, and finishes with guidance on situations where specialist input is needed. [7,8]

An example of an adult epistaxis protocol is shown below: