NCEPOD: Trauma - Who Cares? - London Health Programmes

10Transfershappening. The lack of documented consultant input is aconcern. Either local guidelines exist which obviate the needfor consultant involvement or the process of care, includingtransfers, is being managed and delivered by staff in training.Accompanying staffRecommendations state that a minimum of two attendantsshould be present for the transfer 9 .Of the 194 transfers only 35 (18.0%) had a documentedsecond attendant and 3 (1.5%) a third attendant.In 155/194 cases notifi ed to NCEPOD, the grade of theaccompanying person was not documented. In the 39/194cases where specialty was documented, an anaesthetistor critical care specialist accompanied 36 of the cases.The published recommendations mandate that one of theattendants should be competent in intensive care medicine,anaesthesia or another acute specialty in order to be able tomanage any signifi cant airway complication.Reason for transferThe reasons for transfer were mainly for specialistmanagement of injuries (172/194; 88.7%). Six patients weretransferred due to lack of critical care facilities at the initialhospital. Other reasons cited for transfers were because oflack of local facilities (primarily lack of imaging facilities).The transfers for specialist care are detailed in Figure 51.Of the 172 cases transferred for specialist treatment, themajority were transferred for neurosurgical care – 106/172(61.6%). Six (3.5%) patients were transferred to paediatricunits. Eighteen (10.5%) patients were transferred for burns/plastic surgery input and 7 (4.1%) for the management ofcardiothoracic injuries.While it is essential to transfer patients if the appropriatecare is not available at the initial receiving hospital, it mustbe remembered that this will inevitably incur delays in thetime to defi nitive management. In cases where there is atime critical injury e.g. neurosurgical operation for expandingintracranial haematoma, this type of care may not allowFigure 51. Specialty to which the patients were transferred120Number of patients100806040200NeurosurgeryBurns/plasticsPaediatricsSpinal/neurologyCardiothoracics/thoracicsurgerySpecialtyOrthopaedicsLiverOtherNot recorded121