NCEPOD: Trauma - Who Cares? - London Health Programmes

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Summary of fi ndingsThis study shows a rounded picture ofcurrent trauma care provision in England,Wales, Northern Ireland and the OffshoreIslands. It draws on data provided by theclinicians involved in the care of thesepatients (from questionnaires) and dataextracted from the casenotes. However,these data are accompanied by peerreview, by practising clinicians involved inthe day-to-day care of trauma patients, togive a much richer picture than a purelyquantitative assessment would allow.Almost 60% of the patients in this study received a standardof care that was less than good practice. Defi ciencies inboth organisational and clinical aspects of care occurredfrequently.There were diffi culties in identifying those patients with aninjury severity score (ISS) >16. With large costs involved inboth the provision of care and resources for the managementof these patients it is surprising that that there is no currentmethod of identifying the demand for the management ofthese patients.10
Summary of findingsThe organisation of prehospital care, the trauma teamresponse, seniority of staff involvement and immediate inhospitalcare was found to be defi cient in many cases.Lack of appreciation of severity of illness, of urgency ofclinical scenario and incorrect clinical decision making wereapparent. Many of these clinical issues were related to thelack of seniority and experience of the staff involved in theimmediate management of these patients.It was clear that the provision of suitably experienced staffduring evenings and nights was much lower than at othertimes. In the management of trauma, which very oftenpresents at night, this is a major concern. NHS Trustsshould be open about the differences in care by day andnight and look to address this as a matter of urgency. Publicawareness of these differences may be useful in any debateabout the future confi guration of trauma services.Severe trauma is not common and many hospitals see lessthan one severely injured patient per week. This has a directbearing on experience and ability to manage these challengingpatients. Not only does this relate to clinical skills but also tothe feasibility of providing the entire infrastructure required tomanage the trauma patient defi nitively in all centres.11
Page 1: Trauma: Who cares?A report of the N
Page 4 and 5: ContentsAcknowledgements 4Foreword
Page 6 and 7: AcknowledgementsThis is the twenty
Page 8 and 9: AcknowledgementsThe organisations t
Page 10 and 11: ForewordSevere injury - a car crash
Page 14 and 15: Principal recommendationsOrganisati
Page 16 and 17: IntroductionTrauma remains the four
Page 18 and 19: IntroductionReferences1. Chaira 0,
Page 20 and 21: MethodQuestionnaires and casenotesT
Page 22 and 23: MethodQuality and confidentialityA
Page 24 and 25: CHAPTER 1 - Data overviewFigure 2.
Page 26 and 27: CHAPTER 1 - Data overviewMode of ar
Page 28 and 29: CHAPTER 2 - Organisational dataTabl
Page 36 and 37: CHAPTER 3 - Overall assessmentAll c
Page 38 and 39: CHAPTER 3 - Overall assessmentKey f
Page 40 and 41: CHAPTER 4 - Prehospital careRespons
Page 42 and 43: CHAPTER 4 - Prehospital careFigure
Page 44 and 45: CHAPTER 4 - Prehospital careTranspo
Page 46 and 47: CHAPTER 4 - Prehospital careAdequac
Page 48 and 49: CHAPTER 4 - Prehospital careIn 40/5
Page 50 and 51: CHAPTER 4 - Prehospital carecaused
Page 52 and 53: CHAPTER 5 - Hospital receptionIntro
Page 54 and 55: CHAPTER 5 - Hospital receptionTable
Page 56 and 57: CHAPTER 5 - Hospital receptionTraum
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CHAPTER 5 - Hospital receptionOvera
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CHAPTER 6 - Airway and breathingInt
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CHAPTER 7 - Management of circulati
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CHAPTER 8 - Head injury managementI
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CHAPTER 8 - Head injury managementT
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CHAPTER 8 - Head injury managementA
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CHAPTER 8 - Head injury managementK
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CHAPTER 8 - Head injury management1
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CHAPTER 9 - Paediatric careOrganisa
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CHAPTER 9 - Paediatric careClinical
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CHAPTER 9 - Paediatric careKey find
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CHAPTER 10 - TransfersIntroductionM
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CHAPTER 10 - TransfersArrangement o
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CHAPTER 10 - TransfersFigure 52. De
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CHAPTER 10 - TransfersKey findingsR
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CHAPTER 11 -Incidence of trauma and
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CHAPTER 11 - Incidence of trauma an
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APPENDIX B - Injury severity scoreA
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APPENDIX C - Adult and paediatric G
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APPENDIX D - An example of an excel
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APPENDIX E - Level 1 trauma careAs
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APPENDIX F - ParticipationTrustCase
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APPENDIX G - Corporate structureThe
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Published November 2007 by the Nati
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NCEPOD: Trauma - Who Cares? - London Health Programmes

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