NCEPOD: Trauma - Who Cares? - London Health Programmes

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CHAPTER 1 - Data overviewMode of arrivalTable 3. Mode of arrival to hospitalNumber of patients %Ambulance 652 83.3Helicopter 92 11.7Other emergency service 5
2Organisational dataCHAPTER 2 - Organisational dataThis chapter summarises the collated data from the183 hospitals that returned a completed organisationalquestionnaire. It provides the reader with an overview of thedepartments, facilities, staff and protocols that were availablefor the care of severely injured patients during the studyperiod.Departments and proceduresTable 7 summarises the departments and/or proceduresthat were available at the participating hospitals. It shouldbe noted that some hospitals without a specifi c departmente.g. vascular surgery, did have staff that were able to performsurgical procedures related to that specialty.The most striking, albeit well known fact, was the smallnumber of hospitals that had a neurosurgery department(31) or performed neurosurgical procedures (a furtherseven hospitals). This is of particular concern given thelarge number of severely injured patients who sufferedneurotrauma as part of their constellation of injuries (over60% of patients in this study). The availability in patientservices is also refl ected in the Transfer chapter later in thisreport. By far the most common reason for a secondarytransfer was the requirement for neurosurgery and/orneurological monitoring. Time to defi nitive neurosurgicalintervention can be a major determinant of outcome forpatients with traumatic brain injury and the requirementfor a secondary transfer to access neurosurgical serviceslengthens this time (see Time to surgery page 106).More than half of the patients in the current study presentedto the emergency department out of hours. Furthermore,many required immediate treatment. While in the largemajority of hospitals procedures were available fororthopaedic trauma (168/173) and general surgery (166/173)out of hours, immediate intervention for more specialisedinjuries was often not available.Table 7. Overview of departments and proceduresDepartmenton siteDepartment not on site butspecialty procedures availableSubtotalNotansweredTotalYes Yes NoOrthopaedic trauma 166 7 9 182 1 183Neurosurgery 31 7 132 170 13 183General surgery 173 2 7 182 1 183Vascular surgery 131 15 33 179 4 183Plastic surgery 44 30 98 172 11 183Cardiac surgery 28 7 136 171 12 183Thoracic surgery 31 24 115 170 13 183Maxillofacial surgery 111 13 53 177 6 183ENT 137 14 28 179 4 183Urology 153 13 15 181 2 183Vascular interventional radiology 108 19 47 174 9 18325
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 12 and 13: Summary of fi ndingsThis study show
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 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
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Page 52 and 53: CHAPTER 5 - Hospital receptionIntro
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Page 56 and 57: CHAPTER 5 - Hospital receptionTraum
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CHAPTER 8 - Head injury managementI
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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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