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Wed Nov 21 22:48:54 GMT 2007

Sadly the state of trauma care in the UK is exactly as portrayed in
the NCEPOD report, if not worse.  It depicts clearly the effect of a
lack of a system and lack of any legislated standards of care on the
quality of care delivered to trauma patients, despite this being a
developed country with huge resources.

I'd recommend the report to anyone involved in trauma care, not only
those in the UK, as the findings have implications for all of us.
This is a unique study in that all hospitals in England and Wales are
mandated to submit data to a NCEPOD enquiry, and this is self-reported
data on nearly 800 severely injured patients presenting a country-wide
detailed snapshot of the delivery of trauma care.  Deficiencies in
process of care and their subsequent impact on outcome are relevant to
all of us.

Anyone in the UK who doesn't recognise these deficiencies is frankly
blinkered to reality.  2000-2005 outcomes for severe injury (ISS>15):
UK Mortality 43%; US mortality 16% (these are not figures in the
report, this compares UK TARN data to US NTDB data).

The fault lies not with individual specialties, providers or
hospitals, but with the lack of a appropriately resourced national
trauma system, with legislated standards of care and on-going
monitoring of the health of that system.

This is the latest in a long litany of reports since the Ormond-Clarke
report first recommended a UK trauma system in 1961.  In 2011 it will
be 50 years.  It's about time.

PDF available: http://213.198.120.192/2007b.htm

Karim

On 21/11/2007, Ronald Gross <Rgross at harthosp.org> wrote:
> Jonathan,
>
> We should have all learned a long time ago that much of what is written in today's press is far from being entirely factual.  Personally, I take everything I read or hear in the press with a shaker of salt, 'cause a grain won't do it any more.  This article reminds me of the NYT article about John Holcomb, the "aggressive Army surgeon". Yup, the very same one that I had the pleasure of working with on more that one occasion, usually indirectly, and always with superb outcomes for the ones that matter most - the soldier who I had been entrusted to care for!
>
> Take care, and don't dispair!  UH OH!! I best quit - I'm starting to wax poetic...  :-0
>
> Ron
>
> >>> "Jonathan Marrow" <jonathan at marrow.com> 11/21/2007 12:37 PM >>>
> I could write a long essay in response, Connie.  Whilst I am the first to
> accept that there is lots of room for improvement in trauma care in the UK I
> don't think trauma-list members should accept that the picture you paint is
> the only view of trauma care over here.
>
> I am hoping that someone will be able to take up some of your points in
> detail.   I can't do that right now as I am off to teach on an ATLS Course.
>
> All the best
> Jonathan Marrow
> (UK Emergency Physician)
>
> ----- Original Message -----
> From: "Connie Potter" <Connie at traumafoundation.org>
> To: <trauma-list at trauma.org>
> Sent: Wednesday, November 21, 2007 4:11 PM
> Subject: Trauma Care in the UK
>
>
>
> Trauma care in the UK, with a few exceptions, is similar to that in the
> US in the 60's.  The injured patient is taken to the nearest facility
> where chaos ensues in many situations.
>
> Basically, there is no standard ED triage training (this is a project
> being brought in by a consulting firm from the US called Modeladvice,
> inc.), and no trauma system.  Karen Dunwell at modeladvice.com is
> working with a number of HCA's (see below) to bring their healthcare
> system into the 21st Century.  They have a new website which I have not
> seen but might be of interest to you.
>
> The UK for the past year has been undergoing radical reorganization of
> its Health Care Areas (HCA's) and bringing DRG's into their system.
> They are also focusing on significant problems needing areas of
> improvement such as waiting times for orthpaedic procedures, operations
> that can be done on a outpatient basis (previously none), etc.
>
> You are correct that the UK needs an organized trauma system.  That in
> the US is incomplete as well.  England, Scotland and Ireland also have
> many other basic healthcare operational problems that may take
> precedence over trauma (sound familiar?).  Simple training in our most
> commonly accepted ED triage processes would be a great step for the UK.
>
>
> This was an interesting topic for our Society.
>
> Connie Potter, Executive Director
> National Foundation for Trauma Care
> (505) 525-9511
>
>
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