Multiple rib fractures in trauma patients are associated with significant morbidity and mortality. Delayed morbidity for patients with rib fractures is often a result of hypoventilation leading to atelectasis, pneumonia, and respiratory failure. Pain management was first recognized as an important factor in preventing complications in these patients. Later, management of the respiratory system became more widely recognized as a major factor in patients' care. It is now known that patients with multiple rib fractures benefit most from adequate pain control, rapid mobilization, and meticulous respiratory care to prevent complications. A protocol based on a synthesis of the existing literature is developed. Development of such a protocol for decisions about rapid mobilization, respiratory support, and pain management is the first step in testing the hypothesis that these interventions will decrease the length of patients' stay in intensive care units.