NCEPOD: Trauma - Who Cares? - London Health Programmes

5Hospital receptionFigure 15. Documentation of trauma response (daytime was defined as 08.00–17.59,evening from 18.00-23.59 and night time from 00.00-07.59)Number of patients180160140120100806040200YesNoWeekday Weekend Weekday Weekend Weekday WeekendDay Evening Nightto determine if there was a trauma response. There wassome variation in the activation of the trauma team by time ofday and day of week. The trauma team was less likely to bepresent on a weekday during the day (137/259; 52.9%) thanat nights (100/163; 61.3%) and weekends (168/256; 65.6%).Possible explanations for the variation in trauma teamresponse are:1. Less need for a trauma team during the normal workingday as there was an appropriate consultant response,and supporting team, immediately available within thereceiving emergency department.2. The trauma team had other responsibilities during theworking day and so was less likely to be available to attendthe emergency department for daytime trauma calls.Influence of the severity of injury on the use oftrauma teamsTable 40 describes the infl uence of the severity of injury andthe initiation of a trauma team response. There was a trendtowards greater involvement of trauma teams for patientswith more severe injuries.Table 40. Trauma call documented by ISSTrauma call documentedISS Yes No Total16 - 24 231 218 44925 - 35 185 94 27936 - 75 55 12 67Total 471 324 795While this may appear reassuring it must be rememberedthat this score was calculated retrospectively and cannotdrive real time management decisions. Also many patientswith an ISS in the range 16-24 can pose great challengesand do require the input of a well-organised trauma service.53