Major Trauma

What is major trauma?

Patients with major trauma are those with serious, multiple injuries that require 24/7 emergency access to a wide range of clinical services and expertise. For example doctors may be required to attend to a patient with head and neck injuries, chest, pelvis and other bone fractures. Access to the right service at the right time is crucial for survival.

Why we need to change how we provide major trauma care

Major trauma patients are usually helped through a 999 emergency ambulance response and are taken to the nearest hospital emergency department for treatment. All our East Midlands hospitals with emergency departments will currently treat trauma although many will transfer patients with major trauma on to more specialised centres, sometimes outside the region.

The current service, as described above, is a general response service and we do not have a 24/7 specialist major trauma system in the region. Evidence shows that having a major trauma system could save 20% more lives every year.

We know that patients with severe multiple injuries have a better chance of survival and recovery if we establish a regional Major Trauma system, where all acute hospitals and the East Midlands Ambulance service work together to provide an integrated response.

How we developed our proposals

Assessed current provision

The programme team collected data on major trauma, on where and when it happens. The team took into account the population in each areas, to help anticipate how many people will suffer from major trauma, what/where care will be needed and how many beds are needed across the region. We took into account patient flows across the regional border and anticipated population growth. We also reviewed the strengths and weaknesses of the current services and asked our hospitals which level of service they wanted to provide. We mapped the catchment areas for services, base don a target 45-minute journey time and an agreed triage protocol, in order to develop the most effective system configuration. We took into consideration journey times on both urban and rural roads, teh effects of rush-hour traffic, proposed population expansion and the potential sites for major trauma centres just over the borders of our region.

Our information sources include the TARN (the Trauma Audit Research Netowrk); the East Midlands Ambulance Service; the East Midlands Public Health Observatory; the perforamnce intelligence unit of the strategic health authority and national reports.

Developed service models

Evidence tells us that we require:

One major trauma centre within the East Midlands (A major trauma centre is needed for every three million people and each major trauma centre should see a minimum of 500 patients per annum to be effective).

Local data tells us:

That the number of people across the region who experience major trauma is relatively small at around 660 cases per year, which equates to less than 0.2% of Emergency Department activity.
A clinically appropriate transport time for our geography would be 45 minutes (from assessment at scene to accessing the correct level of service)

In developing our plans we have also taken into consideration:

The plans of the five regions that border the East Midlands
The aspirations of our hospitals
Views of the national trauma lead and the national and local clinical advisory group
Predicted population growth (particularly the Milton Keynes South Midlands (MKSM) growth agenda)

Set minimum standards for services in line with national guidance

We specified minimum standards of care for all levels of service. For example, the major trauma centre must offer 24-hour access to a consultant-led major trauma team. Trauma units must provide selected trauma management with a consultant on call within 30 minutes. All providers must offer appropriate facilities for relatives and clear patient information.

Undertaken gap analyses & development planning

In December 2008, hospital trusts were asked to say which level of centre they would like to provide. A gap analysis in April 2009 highlighted the services trusts already have in place and what needed to be done to bridge any identified gaps.

Nottingham University Hospitals (NUH) was invited to develop a service development plan in order to demonstrate its ability to meet the criteria required to be the region’s Major Trauma Centre. The NUH board is working with the SHA and NHS Nottinghamshire County as lead commissioner for NUH, on the development of its plans to become the regional major trauma centre. These plans still need to be formally approved before NUH can be officially designated as the East Midlands regional trauma centre. Hospitals that aspired to be trauma units were also asked to complete a development plan against their gap analysis.The final configuration of trauma units will be agreed by local PCT commissioning teams. As part of the above process all potential providers were asked to demonstrate how they could meet minimum standards.

It was identified that there is a need for a Major Trauma Network to support the East Midlands trauma and major trauma system. The configuration for the Network is being developed by members of the East Midlands Specialist Commissioning team in conjunction with Major Trauma programme team.

Assessed the impact on health inequalities

The programme carried out an Integrated Impact Assessments on the changes proposed. These included Health Impact and Equality Impact Assessments.

How we involved stakeholders

The proposals stem from a review of health services in 2007 when 4,500 members of the public and 500 health and social care staff gave their views about what mattered to them. This was in response to Lord Darzi’s national NHS review: the Next Stage Review. From this, improving major trauma care was identified as a priority for the East Midlands.

In January 2009 we sought views, ideas and expectations on the proposed changes during a large stakeholder engagement event ‘Consensus-Building Event for Major Trauma’. Those attending included 16 commissioners (including representatives from six of 11 commissioners that serve the East Midlands); 37 providers (including representatives from all nine acute providers that serve the East Midlands), SHA representatives (including representatives from three of the five surrounding SHAs) and one Local Involvement Network (LINks) representative.

During the summer and autumn of 2009, communications and engagement teams from each PCT carried out events to ask people for their views on how best to provide major trauma care in the future. The main objectives were:

To raise awareness of the case for changing the way major trauma is managed in the East Midlands
To explain the potential benefits of a trauma system – in terms of improved access, better care, lives saved and long-term disability avoided
To assess people’s concerns and issues regarding the proposals for a major trauma service
To find out about people’s previous experiences of major trauma (as patients or carers) and explore how services need to be organised to ensure a high-quality experience
To gauge people’s expectations in terms of the access to and quality of a major trauma centre
To encourage informed debate about the journey times to the major trauma centre
To develop an ongoing dialogue with the community around service planning
To allay potential concerns over the impact of changes on local A&E departments
To ensure the project meets its duty to involve, set out in Section 242(1B) of the NHS Act 2006.

Across the region, PCTs received views from more than 400 people. Comments from these events have been collated in a regional report. They are helping us develop a service that meets the needs and expectations of patients, their families and their carers and will continue to inform implementation of all decisions.

During the summer and autumn of 2009 the programme team presented the case for creating a major trauma system in the East Midlands to every OSC in the region and is committed to involving all local OSCs in its ongoing development.

In April 2010 the programme team held a major trauma religious and pastoral workshop with members of the Multi Faith group from Nottingham Queen’s Medical Centre to discuss ensuring that the pastoral/religious needs of major trauma patients and their families/carers could be met.

Your views about major trauma

Other useful links:

Check out how well major trauma services are performing on quality through the East Midlands Quality Observatory