An update on developing a NI Major Trauma Network. Dr Duncan Redmill, Lead Clinician NIMTN Consultant in Emergency Medicine RVH
An Estimation of our True Major Trauma Workload • The societal cost of accidental injury in Northern Ireland is estimated to exceed £4.3 billion annually • Recent TARN data NI incidence suggests approximately 3000 cases pa • This includes 1000 cases > ISS 15 pa.
NI Major Trauma Network 2017 Ambulance Service HSCB / HSC Trusts PHA / DH Nursing & Allied Health Professionals Network Board Service Users Clinical Advisory Group
Trauma is time sensitive
Systems not Structures ‘the workforce is still fragmented in silos and divided by administrative and professional boundaries’ Bengoa Report (2016 )
Clinical Advances to date. • Major Trauma Triage tool • Major haemorrhage in trauma policy • Traumatic cardiac arrest • Emergency resuscitative thoracotomy • Silver Trauma recommendations • Paediatric radiology guidance • Regional patient care pathway • Support to HEMs in developing policy • Whole body CT in adults for major trauma • Regional guidance for the management of multiple rib fractures • Regional approach to trauma team / TILS
Working together. • Regional training programme • TILS training • Trauma ward training • Visiting trust trauma committee • SAI commentary • Engagement with local brain injury charity • Regional mass casualty planning • Damage control surgery conference
TARN reports.
Specific guidance in the elderly.
Actions as per NIMTN Board / CAG (i) Heightened awareness of this population with low severity of mechanism of injury, late identification and prolonged investigation / treatment phase. (ii) Education both pre-hospital with consideration of an appendix for the elderly within the trauma triage tool. Launch an in hospital campaign to include promotion of older persons trauma courses, local presentations and resus posters. (iii) Use of a Silver trauma safety protocol – see resus poster in appendix. (iii) Consideration of unique arrangements required within the NI Major Trauma Network to facilitate timely access to trauma care; in particular early senior review, investigation and transfer to MTC despite late identification if appropriate. (iv) Reconsider Trauma team activation criteria in the older person.
Cross border collaboration A Trauma System for Ireland Report of the Trauma Steering Group “The Department of Health and HSE should continue to explore the potential for all-island collaboration to improve access to trauma services, particularly in border areas”
Damage Control Surgery • DCS conference NI 2018 – Mr Adam Brooks Nottingham. • DSTS course RCS Eng, x22 places booked for MTC surgeons Feb / April / June 19 . • Applying to set up NI DSTS course, to be run from QUB cadaveric facility.
Developing the Major Trauma Service at the MTC Large business case for RVH site approved by HSC early 2019 • Development of an 8 bedded Major Trauma Ward • Led by MDT trauma consultant of the week, Trauma project manager • and patient co-ordinator. Timely input of all relevant specialties • AHP support, nursing, HCA, Physio / OT, rehabilitation, psychology • Development of TIG trauma fellowship at RVH • Developing a business case for Paediatric MTC status • Increased pool of TARN data co-ordinators • Visit East Midlands MTC April 19 • Running a virtual trauma service currently • Cohorted patients do better •
Timescales • HEMs landing site RVH – March 2019 • Call and send proposal April 2019 • Trauma bypass and repatriation August 2019
Call and send proposal.
Referral / Reverse referral policy.
Repatriation
Potential Advances in next 12 months Call and Send launched / phased ? • Trauma ward opens • Trauma network / bypass launched • HEMS service expands – blood products / trauma retrieval / HEMS landing at • RVH Elderly trauma care development • Trauma coagulopathy pathway • Rehabilitation roles expanded including AHP / psychology support • TARN data collectors expansion • Regional trauma training including TWILS • DSTS local course • Ortho plastics service at RVH expands • Trauma research •
I want an operation. In the best place. By experts, who talk to each other and who talk to me. When I’m ready. After I’ve been fixed, it’s up to me. But I need people to show me what to do and to answer my questions so I can regain my independence and start to enjoy life again……………… Anon, Major Trauma Patient.
Recommend
More recommend
