Analysis

England’s trauma care network proves its worth

Report finds that setting up major trauma centres in England has saved 1,600 extra lives 

Report finds that setting up major trauma centres in England has saved 1,600 extra lives  

Trauma_unit
Picture: iStock

It is perhaps a sign of how antiquated serious emergency care was before the creation of the trauma network model in 2012, that the system had been largely unchanged since the start of the NHS.

Until the re-organisation, patients who had been seriously injured, for example in road accidents, shootings or stabbings, were simply taken to the nearest hospital emergency departments.

This situation changed in London eight years ago and outside the capital two years later.

Today, there are 17 networks with 27 designated major trauma centres in England supported by more than 100 local trauma units.

1,600

extra lives saved since 2012

As a result of this trauma network being set up, patients are assessed at the scene and may be transported to sites many miles away.

When the network was set up those who worked in trauma care argued it would save lives; it seems now this has been confirmed.

‘Silver trauma’

A report by Manchester University’s Trauma Audit and Research Network suggests about 1,600 people are alive today thanks to the changes.

The researchers looked at 110,000 major trauma cases over the past nine years (2008-09 to 2016-17). They found that, since 2012, taking into account the age and condition of the patients, their chances of survival have increased by 19%.

19%

increase in survival rates

The average age of patients at the end of the study period was found to be 14 years older than at the start because of a rise in ‘silver trauma’, in which older people have sustained serious injuries from falls.

The study, published by the Lancet and reported in EClinicalMedicine, said the network appears to have improved several aspects of care, such as access to consultants and scans, and treatment to stop severe bleeding.

NHS England national clinical director for trauma care Professor Chris Moran says the results are pleasing and show the importance of getting patients to ‘specialist centres staffed by experts’.

Survival rates

He also believes that, as the trauma networks mature over the next few years, more lives will be saved.

‘We are confident that we will continue to see further increases in survival rates.’

But the researchers say that improvements in trauma care have not only been down to the major trauma centres. Local units have also played a vital role and still treat many serious trauma patients.

As well as making patient triage more effective, it seems the changes have lifted standards across the board.

Justin_Walford_
Justin Walford

RCN Emergency Care Association member Justin Walford says this is likely to be because of a culture of ‘shared learning’ that has been created by the networks.

Mr Walford moved from a district general hospital in Worthing to work in a major trauma centre – the Brighton and Sussex University Hospitals NHS Trust – following the re-organisation.

He says they are focusing on learning from mistakes and developing expertise.

‘We have been delivering multi-professional training around the network to our trauma units, and doctors, nurses and paramedics are all benefiting.

Learning from incidents

‘There is also a recognition about the importance of learning from incidents that have poor outcomes.

‘Recently, a patient deteriorated and had a traumatic cardiac arrest, which are treated differently from normal cardiac arrest.

‘After a debrief, the department reviewed the case and provided supplemental training to doctors and nurses based on the lessons that were learnt. This culture of learning is a real noticeable change.’

91%

of patients survived major trauma in 2016-17

National Major Trauma Nursing Group chair Robert Pinate says the study provides a real justification for the changes that were introduced.

‘You have to remember they were controversial in places at the time and ruffled a few feathers.

‘People never like the idea of their local hospital losing out in any way. But we had good evidence from other places, such as Australia, that the re-organisation would work – and it is great to see that it has.’

He says it has had a ‘massive’ impact on trauma nursing by helping to define it as a specialty.

Competencies

Since 2012, the group has launched a number of sub-groups, including paediatrics, adult critical care, adult trauma wards and rehabilitation, that have since started developing sets of competencies for nurses in these fields.

So far, three have been published and another two are imminent.

‘By developing the competencies, we have encouraged trusts to really think about how they support their trauma nurses and we have seen some really good examples of training being developed.

If you look at the national quality indicators, you can see the change.

‘When they first came out there was just one reference to nursing and it was hidden away, now it is completely different – nursing is an important part.’

Rest of UK is playing catch-up

The NHS in England has led the way on trauma care in the UK and six years after the creation of the national network, Wales, Scotland and Northern Ireland are still playing catch-up.

Last year, the Scottish government announced £5 million of funding to centralise trauma care around four sites in Glasgow, Edinburgh, Aberdeen and Dundee.

Ministers had initially hoped the network would be up and running by 2016, but it is now not expected to be completed until 2020.

Meanwhile, in Northern Ireland, plans to focus trauma care in Belfast are still not fully realised.

The NHS in Wales this year agreed on a plan to centre trauma care in south and west Wales in Cardiff. It took four years of talks and consultations to get to this point, with the changes proving controversial as local politicians attempted to block the move.

This is despite evidence from North Wales, which has been part of England’s North West Midlands Trauma Network since 2012, that such a move could save lives.

It is still expected to take another year or two before the Welsh government will give the Cardiff plan the final clearance and the new system can be introduced.

 

How trauma shake-up helped after terror attacks

London was the first part of the UK to adopt the trauma network model. In 2010, services were re-organised into four trauma centres supported by more than 30 local units.

The benefits were realised during the 2017 terror attacks in Westminster, London Bridge and Finsbury Park. Of nearly 100 casualties, only two died in hospital.

In the largest attack, at London Bridge, 36 patients were treated across three major trauma centres and two units. Teams on the scene triaged patients and coordinated where they were sent.

Only two the patients who were sent to a trauma unit had to be transferred to a major trauma centre for ongoing care. In contrast, during the 2005 London bombings, one hospital received nearly 200 casualties in just a few hours.


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Nick Evans is a freelance health writer

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