Major Trauma – How we deal with it….. Mark Ainsworth-Smith Consultant Pre-Hospital Care Practitioner SCAS mark.ainsworth-smith@scas.nhs.uk

Major Trauma - a problem? An overview Trauma is the leading cause of death in the under 40s

Major Trauma - a problem? 20 000 cases of Major Trauma / year in England 5400 deaths Equates to 5.4 patients per day across the SCAS region Lost economic output of £3.3-3.7 billion / annum

What is Major Trauma? Major Trauma Injury Severity Score (ISS) >15 Complex, typically multi-system injury Serious Injury ISS 9-15 Serious injury to a single system The principle: Patients with “Major Trauma” should transported (from the scene) directly to Major Trauma Centres

An ISS score An example of a patient with a cerebral contusion, femur fracture and flail chest Region Injury Description AIS Square Top Three Head & Neck Cerebral Contusion 3 9 Face No Injury Chest Flail Chest 4 16 Abdomen No injury Extremity Fractured femur External Injury Severity Score 34

Some causes of Major Trauma “Injuries can be caused by any combination of external forces that act physically against the body” Falls <2 metres Falls >2 metres Penetrating trauma (stabbing) Hanging Burns Road Traffic Incidents

The good news………

A 999 call is received in our Clinical Coordination Centre (CCC): A car has crashed into a lamp post at high speed Witnesses report that there are 2 casualties: 1 possibly deceased 1 with critical injuries

The triage process To decide the urgency of the call we use NHS Pathways in both the NHS 111 service and the 999 emergency service. NHS Pathways is a clinically based telephone triage tool that allows us to find the appropriate response Pathway for the patient’s presentation. This may be Emergency Ambulance, Non Emergency Ambulance, Referral to GP, Self Care etc.

Response Categories Where an Emergency Ambulance response is required, NHS Pathways clinically categorizes the calls into: Category 1 Calls – 7 minute first response Category 2 Calls – 18 minute first response Category 3 Calls – 120 minute first response Category 4 Calls – further assessment by a clinician over the telephone OR 180 minute response

How do we decide the urgency? Category 1 Life-Threatening Calls: Cardiac Arrest Choking Stroke Fitting Unconsciousness with abnormal or noisy breathing Drowning

How do we decide the urgency? Category 2 Emergency Calls: Allergic Reactions Sepsis (High NEWS / NEWS2) Chest Pain (cardiac) Bleeding Diabetic Problems Severe Burns Major Trauma

The types of SCAS resource we send

Patient triage at the scene P1 Critically Injured (immediate) P2 Seriously Injured (urgent) P3 Walking Wounded (delayed) Dead Unless a crime scene is declared then all deceased patients under the age of 18 will be conveyed to hospital – even if resuscitation is not ongoing. This ensures: Family welfare Staff welfare Police involvement (and FLOs)

Responsibilities at the scene of the incident To save life is common to all emergency services. Additionally: The police will be automatically contacted when the call is received in the CCC. Their main role is to: To manage the scene Ensure scene safety Investigate and preserve evidence The fire service will be contacted (if required). Many firefighters have been trained by SCAS to deal with immediately life-threatening injuries. Their main role is to: Prevent escalation Eliminate hazards Rescue trapped casualties

The ambulance service will focus on: Triage Treatment: <C> - Control of catastrophic haemorrhage A Airway B Breathing C Circulation D Disability E Exposure / Maintenance of temperature Transport to most appropriate destination

Destination choices In the SCAS region there are 2 Major Trauma Centres (MTCs) at: John Radcliffe Hospital, Oxford University Hospital Southampton There are also Trauma Units (TUs) at: Milton Keynes, Stoke Mandeville, Wexham Park, Royal Berkshire, North Hampshire (Basingstoke), Queen Alexandra, Frimley Park, Poole and Salisbury And “Local Emergency Hospitals” at: The Horton, Wycombe, Winchester and Bournemouth

The aim….. The aim is for patients with major trauma to be transported directly to MTCs unless they are too unwell to travel i.e. when there is: Airway compromise Catastrophic haemorrhage Imminent Cardiac Arrest Paradoxically this means that some of our most critically unwell patients are treated in Trauma Units (not MTCs)

Destination Choice

ePR SCAS Data – all trauma

All trauma by Age – SCAS ePR

Road Traffic Collision - Age

Gender

An example of the type of information….. Road Incidents

An example of the type of information….. Road Incidents (Motorcycles)

RTC – day of the week / hour

Conclusion Data is key and can be used to : Identify who, where, when, why and how patients are being injured Improve deployment of SCAS resources Improve our prevention strategies through joint working i.e. Other emergency services Trauma Networks CDOP

Any Questions?