1. Road Traffic Related Deaths The Cambridgeshire Trauma Audit and Research Project Roderick Mackenzie BSc PhD MRCP David Beaven BSc SR Para

2. Road Traffic Collisions Principle cause of death and injury Priority for national and local government Epidemiology in Cambridgeshire unclear The nature and effect of pre-hospital interventions not clearly established No mechanism for the prospective collation and analysis of the available data

3. CASUALTY A PRF EAS H H H D ICS IRF Data sources and relationships CCC CHA FP TARNTARN FDRS19 C

4. Cambridgeshire Trauma Audit and Research Project Cambridgeshire Trauma Audit and Research Project Incident Injury Outcome Intervention

5. Aims of CTARP Create a trauma registry for Cambridgeshire To link clinical data with incident data To develop the registry such that it can be used for prospective data collection during specific controlled trials of pre-hospital and emergency department interventions

6. Aims of the retrospective analysis of road traffic related deaths Describe epidemiology of road traffic related deaths Identify relevant data sources, flows and mechanisms for accessing data Inform the development of an inter-agency information sharing protocol which can be used for the living

7. Methods Retrospective review of all road traffic related deaths in the county over a four year period (Jan 97 to Jan 01) Link data from Police Accident Enquiry Unit, Coroners, Ambulance Service, A&E departments, Immediate Care Scheme.

8. Results 284 fatalities over 4 year period analysis of 248 patients in 226 incidents time of death obtained in 241 patients 92 patients arrived in hospital 59 patients with RTS and Ps data 23 patients with Ps > 0.5

9. Who are the casualties ?

11. What happened ?

12. Where did they die ?

13. When did they die ?

14. Why did they die ?

16. Were any preventable ?

17. 5 patients drowned 5 patients with airway obstruction or asphyxia 23 patients with Ps > 0.5 Immediate Care Doctor on scene in 160 incidents Ambulance to scene mean 12 min (SD 6 min, n = 188) Time to hospital TrappedNot trapped mean 74 min mean 49 min ( SD 22 min, n = 28)(SD 17 min, n = 46)

18. Were any preventable ? 2 refused treatment (blood products) 8 head injuries (? underscored) 4 intra-operative deaths 5 infection (late) 2 acute medical emergencies (CVA/PE) 1 severe pre-existing disease (AMI) 1 ? fluid overload

19. Information Sharing Define purpose of data flow (epidemiological investigation and research) Identify data flows Analyse data flows for patient identifiable data Test data flows against the Caldicott and Data Protection principles Alter flows to comply with principles

20. The next steps... Draft and ratify inter-agency information sharing protocol Develop database Initiate data collection

21. Questions and comments

22. The Caldicott Principles Justify the purpose Don’t use patient identifiable information unless it is absolutely necessary Use the minimum necessary patient identifiable information Access to patient identifiable information should be on a need-to-know basis Everyone should be aware of their responsibilities Understand and comply with the law

23. Data Protection Principles Data must be processed fairly and lawfully Personal data shall be obtained only for one or more specified and lawful purpose Personal data shall be adequate, relevant and not excessive Personal data shall be accurate Personal data processed for any purpose shall not be kept longer than is necessary for that purpose Personal data shall be processed in accordance with the rights of the data subjects under the 1998 Data Protection Act Appropriate technical or organisational measures must be taken against unlawful or unauthorised processing of the data