1. Major Trauma – How we deal with it…..
Mark Ainsworth-Smith
Consultant Pre-Hospital Care Practitioner SCAS

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

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

4. 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

5. 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

6. 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

7. The good news………

8. 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

9. 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.

10. 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

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

12. 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

13. The types of SCAS resource we send

14. 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)

15. 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

16. 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

17. 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

18. 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)

19. Destination Choice

20. ePR
SCAS Data – all trauma

21. All trauma by Age – SCAS ePR

22. Road Traffic Collision - Age

23. Gender

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

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

26. RTC – day of the week / hour

27. 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

28. Any Questions?