Oxford University Hospitals NHS Foundation Trust

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Major Trauma Centre: questions and answers

What is major trauma?

Major trauma describes serious and often multiple injuries where there is a strong possibility of death or disability. These might include serious head, chest, abdominal and skeletal injuries sustained as a result of accidents, sport or violence. Major trauma is the main cause of death for people under the age of 45 and is a major cause of debilitating long term injuries. More than half of major trauma is caused by road traffic accidents.

What is a Major Trauma Network?

Major trauma networks are organised groups of services and personnel, who serve a defined population and aim to reduce death and disability following injury. The three overlapping phases (pre-hospital, in-hospital and rehabilitation) of a patient's journey require organisation so that patients are treated at the time and place that most benefits them, which a major trauma network is best suited to deliver.

The major trauma network has been established under the following principles, as defined by Professor Keith Willett, the national clinical director for trauma:

  • a network based around the needs of individuals irrespective of where they suffer those injuries
  • a network that delivers the patient as rapidly and safely as possible to the hospital that can manage the definitive care of their injuries either directly or by expedited inter-hospital transfer
  • a network that supports the victim's family
  • a network that defines a comprehensive prescription for rehabilitation and, importantly, pre-hospital phase, in hospital phase and rehabilitation phase
  • a system that moves the responsibility for definitive patient care from the receiving clinical team to the trauma network when the initial receiving unit is incapable of that care.

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What is a Major Trauma Centre?

A major trauma centre (MTC) is part of a major trauma network. It is a specialist hospital responsible for the care of the most severely injured patients involved in major trauma. It provides 24/7 emergency access to consultant-delivered care for a wide range of specialist clinical services and expertise. A hospital which is a designated major trauma centre will have an A&E department.

What is a Major Trauma Unit?

A major trauma unit is a hospital that is part of the major trauma network providing care for all except the most severe major trauma patients. When it is not possible to get to the major trauma centre within 45 minutes, or where the patient needs to be stabilised quickly, the patient is taken to the nearest hospital with a local trauma unit for immediate treatment and stabilisation before being transferred on to the major trauma centre. Once discharged from a major trauma centre, local trauma units also provide on-going treatment and rehabilitation for patients. A hospital which is a designated trauma unit will have an A&E department.

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Why do we need to change the way major trauma services are provided?

There are approximately 4,000 major trauma patients (children and adults) across the south of England each year. Whilst this is a relatively small number from a population of 13.4 million, major trauma patients have complex injuries and need expert care to have the best chance of surviving and recovering.

Whilst all hospitals with A&E departments across England treat both adults and children involved in major trauma, good patient outcomes have been lower than in healthcare systems in equivalent western economies (National Audit Office Report, 2010) where major trauma networks are already fully operational.

In many of the hospitals across the country that have already been providing major trauma care, there was insufficient clinical cover and activity levels did not allow staff to maintain the expert skill levels required to treat these patients. Due to the frequent need to transfer patients to more specialist centres, this also presented a potential problem of unacceptable delay in treatment.

With the implementation of a major trauma network, there is a much better chance of surviving and recovering from a major trauma injury. Patients have direct access to specialist teams and state-of-the-art equipment to ensure they receive immediate treatment, 24 hours a day, seven days a week.

How many people suffer major trauma a year?

In the south of England, there are approximately 4,000 major trauma patients a year.

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How many major trauma patients will the new centres treat?

On average, each Major Trauma Centre will treat two to three people a day.

What will happen to a major trauma patient under the new system?

Patients with a severe injury are assessed by ambulance staff at the scene of the incident. They are then taken by ambulance direct to the nearest major trauma centre if it is safe to do so and the patient does not need stabilising. At the major trauma centre, patients are cared for by an on-site team, including experts in diagnostic tests, trauma injuries and brain surgery.

If a patient needs to be stabilised first, he or she is taken to the nearest trauma unit. For less severe injuries, patients are taken to the nearest trauma unit.

Patients with less severe injuries, urgent or emergency care needs will continue to be treated by their local A&E, Minor Injuries Unit or GP.

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Will major trauma patients have longer ambulance journey times?

In some cases, patients may have to travel longer in the ambulance to a major trauma centre than they would have done if they were being taken to their local A&E. However, the journey is very unlikely to take longer than 45 minutes and it means patients are treated in a specialist centre with all the facilities and expertise they may need. They will not need to be transferred from a local hospital or trauma unit, which would incur delays to treatment and could have adverse effects on survival.

When it is not possible to get to a major trauma centre within 45 minutes, patients will be taken to the nearest hospital with a local trauma unit for immediate treatment and stabilisation before being transferred on to a major trauma centre.

For major trauma patients, spending a little extra time getting to a hospital which provides the right team of specialists is more important than getting to the nearest hospital. Specialist treatment at a major trauma centre has a greater impact than journey time (ie, the time spent in an ambulance) on medical outcomes and can increase survival rates by up to 20 percent (National Audit Office Report, Major Trauma Care in England 2010).

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Are major trauma services the same for children as they are for adults?

Major trauma in children is thankfully very rare indeed. We are fortunate in the south of England to have a number of highly specialised facilities for the care of critically ill children. The initial system is the same for children with consultant delivered resuscitation. A small number of children may then require transfer to one of the highly specialised facilities.

What are the benefits of having a major trauma network?

The benefits associated with implementation of a major trauma network are:

Patient outcomes will be improved

  • The National Audit Office have estimated that between 400 and 600 lives could be saved per year across England.
  • Major trauma patients will receive world class care from specialist teams providing 24/7 emergency access to consultant-delivered care.
  • Long term disability will be reduced by improving outcomes for adults and children involved in major trauma.
  • Major trauma patients will require less long-term NHS care.
  • Through the provision of specialist care and rehabilitation, patients will have an improved ability to return to work and undertake recreational activities.
  • The NHS is able to better plan for and respond to major incidents, thus improving the care major trauma patients will receive.

Mortality rates associated with major trauma will be reduced.

  • International experience of implementing major trauma networks has seen a 15 - 25 percent decrease in mortality over a period of five years.

The major trauma network will facilitate the establishment of more effective clinical teams.

  • To ensure best outcomes for major trauma patients, hospitals specialising in major trauma need to have specialist doctors and clinical support staff available at all times. The major trauma network will facilitate delivery of this.

The major trauma network is a long-term sustainable service due to it facilitating the reduction of associated costs and more effective use of resources

  • Having major trauma centres and units specialising in major trauma is a more cost effective way of caring for patients.
  • The launch of the major trauma network will ensure the best use of resources, making the major trauma centres and trauma units more sustainable.

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Will existing major trauma patients be affected?

No, many of the major trauma centres and major trauma units have already been working under the new network system and existing patients will continue to receive the high standard of treatment, care and rehabilitation already provided.

Will any hospitals close because of this?

No, there will not be any hospital closures as a result of the major trauma network launch.

Will A&E departments be affected?

No, introduction of a major trauma network is not about reducing A&E services nor will A&E departments be affected. The change is focused on enhancing strategically-placed services to ensure that the relatively few people who suffer major trauma get the best care as quickly as possible.

A&E departments will continue to receive patients with injuries that need urgent treatment, but do not require specialist services, as is the case with major trauma patients.

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My local hospital isn't a major trauma centre / unit - will this affect the level of care a local major trauma patient may get?

No, under the new system all major trauma patients can expect to receive the same standard of care, regardless of when and where they are when suffering a severe injury. In some cases, patients may have to travel longer in the ambulance to a major trauma centre than they would have done if they were being taken to their local A&E. However, the journey is very unlikely to take longer than 45 minutes and it means patients will be treated in a specialist centre with all the facilities and expertise they may need. They will not need to be transferred from a local hospital or trauma unit, which would incur delays to treatment and could have adverse effects on survival.

When it is not possible to get to a major trauma centre within 45 minutes, patients will be taken to the nearest hospital with a local trauma unit for immediate treatment and stabilisation before being transferred on to a major trauma centre.

For major trauma patients, spending a little extra time getting to a hospital which provides the right team of specialists is more important than getting to the nearest hospital. Specialist treatment at a major trauma centre has a greater impact on journey time (ie the time spent in an ambulance) on medical outcomes and can increase survival rates by 20 percent (National Audit Office Report, Major Trauma Care in England 2010).

Patients with less serious injuries, urgent or emergency care needs will continue to be treated by their local A&E, Minor Injuries Unit or GP.

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