NCEPOD: Trauma - Who Cares? - London Health Programmes

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CHAPTER 10 - TransfersFigure 52. Delay in transfer/retrievalNumber of patients1009080706050403020100TransferRetrievalYesNothe optimal outcome. Given these clinical considerationsand the constraints of staffi ng in a time of changing trainingand working hours, it is probably time to consider carefullywhich hospitals receive severely injured patients and to plana proper regional trauma service. Patient transport servicesand the role of doctors in prehospital care must be anintegral part of any plans to change trauma services. Both ofthese plans must occur in parallel as part of a wider traumacare network 12 .Appropriateness of transferNinety one out of the 194 (46.9%) transfers were consideredappropriate by the advisors and 17 (8.8%) transferswere considered inappropriate. There were insuffi cient orincomplete data to comment and classify the remainder ofthe transfers.The reasons identifi ed for the inappropriateness of thetransfers included:Timeliness of transferFigure 52 shows information on timeliness of transfer. Whereit could be assessed there were delays in 26.4% (34/129) ofall transfers and 50% (4/8) of retrievals.• transfers with unsurvivable injuries (burns case),• failure of closer centre to accept the patient and,therefore, a longer and delayed transfer wasneeded,• failures in effective communication betweenhospitals, and• missed injuries.122
10TransfersCase study 6A young patient had a severe brain injury following afall. The patient had a GCS of 3 at presentation withunresponsive pupils and a compound skull fracturewith brain matter exuding from the ear. The patient wastransferred to a neurosurgical unit but certifi ed braindead shortly after arrival.In addition, there were some concerns over the transfer of anumber of patients who had sustained a head injury. Fromthe records available six patients with a Glasgow ComaScore of less than 10 were transferred without intubation.Case study 7An elderly patient tripped while intoxicated. A GlasgowComa Score of 3 was recorded in the ambulance. At thereceiving hospital it was recoded as 8. The hospital wasunable to perform a CT head scan therefore the patientwas transferred to the local neurosurgical hospital. Thetransfer was performed without securing the airway. Atthe neurosurgical hospital the patient was transferredto CT still with an unprotected airway. Intubation wassubsequently performed after CT scanning.The recommendations on the transfer of patients with headinjuries 7 state that only in exceptional circumstances shoulda patient with a signifi cantly altered conscious level requiringtransfer not be sedated, intubated and ventilated.This review gives a picture of a haphazard arrangement forthe secondary transfer of severely injured patients. It is ofgreat concern that one in four patients required secondarytransfer to receive defi nitive care and this must be a majorcriticism of the current arrangements for the managementof severely injured patients. There were defi ciencies in localprotocols, use of national guidelines, consultant oversightand documentation.Furthermore, avoidance of transfers by the initial directtransport of the severely injured patient to a centre withthe appropriate facilities should be considered. This wouldneed regional planning of all aspects of the trauma serviceincluding the prehospital emergency services.123
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Trauma: Who cares?A report of the N
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ContentsAcknowledgements 4Foreword
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AcknowledgementsThis is the twenty
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AcknowledgementsThe organisations t
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ForewordSevere injury - a car crash
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Summary of fi ndingsThis study show
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Principal recommendationsOrganisati
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IntroductionTrauma remains the four
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IntroductionReferences1. Chaira 0,
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MethodQuestionnaires and casenotesT
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MethodQuality and confidentialityA
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CHAPTER 1 - Data overviewFigure 2.
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CHAPTER 1 - Data overviewMode of ar
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CHAPTER 2 - Organisational dataTabl
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CHAPTER 3 - Overall assessmentAll c
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CHAPTER 3 - Overall assessmentKey f
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CHAPTER 4 - Prehospital careRespons
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CHAPTER 4 - Prehospital careFigure
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CHAPTER 4 - Prehospital careTranspo
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CHAPTER 4 - Prehospital careAdequac
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CHAPTER 4 - Prehospital careIn 40/5
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CHAPTER 4 - Prehospital carecaused
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CHAPTER 5 - Hospital receptionIntro
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CHAPTER 5 - Hospital receptionTable
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CHAPTER 5 - Hospital receptionTraum
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CHAPTER 5 - Hospital receptionTable
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CHAPTER 5 - Hospital receptionThese
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CHAPTER 5 - Hospital receptionOvera
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CHAPTER 6 - Airway and breathingInt
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CHAPTER 6 - Airway and breathingFig
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CHAPTER 6 - Airway and breathingFig
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CHAPTER 6 - Airway and breathingTab
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CHAPTER 7 - Management of circulati
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Page 114 and 115: CHAPTER 9 - Paediatric careOrganisa
Page 116 and 117: CHAPTER 9 - Paediatric careClinical
Page 118 and 119: CHAPTER 9 - Paediatric careKey find
Page 120 and 121: CHAPTER 10 - TransfersIntroductionM
Page 122 and 123: CHAPTER 10 - TransfersArrangement o
Page 126 and 127: CHAPTER 10 - TransfersKey findingsR
Page 128 and 129: CHAPTER 11 -Incidence of trauma and
Page 130 and 131: CHAPTER 11 - Incidence of trauma an
Page 136 and 137: APPENDIX B - Injury severity scoreA
Page 138 and 139: APPENDIX C - Adult and paediatric G
Page 140 and 141: APPENDIX D - An example of an excel
Page 142 and 143: APPENDIX E - Level 1 trauma careAs
Page 144 and 145: APPENDIX F - ParticipationTrustCase
Page 150 and 151: APPENDIX G - Corporate structureThe
Page 152: Published November 2007 by the Nati
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