NCEPOD: Trauma - Who Cares? - London Health Programmes

More documents

Recommendations

Info

CHAPTER 2 - Organisational dataTable 23. Specialty of trauma team by residencyConsultantEmergency MedicineSpR or aboveAnaesthetic SpRor aboveSurgical SpR orabove% % % %Resident 6 3.3 109 59.6 111 60.7 86 47.0Non resident 59 32.2 36 19.7 13 7.1 34 18.6Not present 118 64.5 38 20.8 59 32.2 63 34.4Total 183 183 183 183The majority (134/143) of hospitals with a formal traumateam had a written protocol for activating a trauma response.To determine who would respond to a severely injured patientout of hours, we asked for a list of the grades, specialties,ATLS and residency status, for each of the clinicians whowere on call on Sunday February 5th 2006 at 2am.Despite the recommendation that the trauma team leadershould be a consultant 3 , the majority of hospitals (118/183) didnot have consultant presence for the management of majortrauma during the early hours of Sunday morning on February5th 2006. Furthermore, in only six cases was the consultanta resident and thus immediately available (Table 23).Immediate airway control is vital. Only 111/183 hospitals(60.7%) had an anaesthetic SpR or above immediatelyavailable. <strong>Trauma</strong> airways are likely to be diffi cult and ananaesthetic SpR or above should be present immediately inthe emergency department.The management of the severely injured patient can beextremely challenging and rapid, accurate communication ofall aspects of care is essential. This is particularly importantgiven that many different specialties may be involved. It canbe seen from Table 24 that only 51/175 hospitals had writtenprotocols covering this important area.Table 24. Communication and handoversWritten protocol forhanding over careClinical teamsClinical specialties% %Yes 59 33.1 51 29.1No 119 66.9 124 70.9Subtotal 178 175Notanswered5 8Total 183 183Over a third (65/183) of hospitals indicated that they did notallocate a named person for communicating with the patient/relatives. This insuffi ciency was refl ected by the individualcases. Where the advisors felt they were able to assess thelevel of communication with the patient/relatives, 31.4%(141/449) of cases were found to be less than satisfactoryfor quantity and quality of communication. This clearlyindicates that a named person of appropriate senioritymust be nominated to the patient/relatives as a point ofcontact. Communication with the patient/relatives must bedocumented to allow all involved with the care of the patientto be aware of the occurrence and content ofthis communication.32
2Organisational dataKey findingsRecommendationsMany severely injured patients are taken to hospitals thatdo not have the staff or facilities to provide defi nitive care.In this study only 17 hospitals had the range ofspecialities available to be considered for a Level 1<strong>Trauma</strong> Centre (under the verifi cation system of theAmerican College of Surgeons).39.3% (72/183) of hospitals did not have a residentanaesthetist at SpR level or above.65% (118/183) of hospitals stated that a consultant wasnot involved in the initial care of a severely injured patientwho presented at 0200 on Sunday 5th February 2006.There is a need for designated Level 1 trauma centresand a verifi cation process needs to be developedto quality assure the delivery of trauma care (as hasbeen developed in USA by the American College ofSurgeons). (Royal College of Surgeons of England,College of Emergency Medicine)All hospitals receiving trauma cases should have at leastfour resuscitation bays. (Hospital trusts)All hospitals receiving trauma patients should have aresident SpR or above with the skills to immediatelysecure the airway in trauma patients. (Hospital trusts)There should be a CT scanner within or adjacent to theresuscitation room. (Hospital trusts)Each trust involved in trauma care should develop acore group of clinicians with a special interest in traumamanagement. This trauma care delivery group shouldinclude a member of the trust executive staff. (Hospital trusts)References1. http://www.rcr.ac.uk/docs/radiology/worddocs/RCRStandardsforCT11thNov2003webed.doc2. A Darzi. Framework for Action. 2007.http://www.healthcareforlondon.nhs.uk/framework_for_ action.asp3. The Royal College of Surgeons of England and the BritishOrthopaedic Society. Better Care for the Severely Injured.200033
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 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
Page 58 and 59: CHAPTER 5 - Hospital receptionTable
Page 60 and 61: CHAPTER 5 - Hospital receptionThese
Page 62 and 63: CHAPTER 5 - Hospital receptionOvera
Page 64 and 65: CHAPTER 6 - Airway and breathingInt
Page 66 and 67: CHAPTER 6 - Airway and breathingFig
Page 68 and 69: CHAPTER 6 - Airway and breathingFig
Page 70 and 71: CHAPTER 6 - Airway and breathingTab
Page 72 and 73: CHAPTER 7 - Management of circulati
Page 84 and 85:
CHAPTER 7 - Management of circulati
Page 86 and 87:
CHAPTER 7 - Management of circulati
Page 88 and 89:
CHAPTER 8 - Head injury managementI
Page 90 and 91:
CHAPTER 8 - Head injury managementT
Page 92 and 93:
Page 94 and 95:
CHAPTER 8 - Head injury managementA
Page 96 and 97:
Page 98 and 99:
CHAPTER 8 - Head injury managementH
Page 100 and 101:
CHAPTER 8 - Head injury managementC
Page 102 and 103:
CHAPTER 8 - Head injury managementf
Page 104 and 105:
Page 106 and 107:
Page 108 and 109:
CHAPTER 8 - Head injury managementF
Page 110 and 111:
CHAPTER 8 - Head injury managementK
Page 112 and 113:
CHAPTER 8 - Head injury management1
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 124 and 125:
CHAPTER 10 - TransfersFigure 52. De
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 132 and 133:
Page 134 and 135:
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 146 and 147:
Page 148 and 149:
Page 150 and 151:
APPENDIX G - Corporate structureThe
Page 152:
Published November 2007 by the Nati
show all

NCEPOD: Trauma - Who Cares? - London Health Programmes

Create successful ePaper yourself

Delete template?

Save as template?