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Sun Nov 25 11:05:11 GMT 2007

Emergency department care in the UK is good - in fact on a national level
it's at least on par if not better than emergency department care across the
US.  The specialty of emergency medicine is more evolved, care is more
consistent, there are national standards which are (generally) maintained.
Indeed trauma mortality rates fell in the UK between 1989 & 1994 with the
widespread introduction of ATLS and trauma teams.  

Unfortunately Trauma is seen as being synonymous with the Emergency
Department, and it clearly is not.  The ED is one link in the chain and
without quality care further down the chain, especially definitive surgical
care (and getting to it) quite frankly you may as well not bother.  This I
believe is what is meant by those who state 'Trauma is a Surgical Disease'.
Undoubtedly optimal trauma care is totally reliant on prehospital care,
emergency medicine, anaesthesia, critical care etc.  But fundamentally most
of these patients require operations - often many of them. 

Patterns of injury are actually pretty similar in the US and the UK.  Most
of the US is not highly urbanised and penetrating trauma is uncommon.
Penetrating trauma rates have fallen across the US over the past decade.
Overall penetrating trauma rates in the UK are around 3%, but as in the US
it raises in inner cities.  Our penetrating rate at the Royal London is
currently at 28% - although the majority is still knife related.  (London's
homicide rate is higher than New York's).

Mark's post lists a litany of deficiencies - but the central theme is that
there is no system and no standards that that system is held accountable to.
However all is not quite gloom.  If you live in North East London where
there is a model trauma system in place, or if you are brought to us from
further afield by one of the helicopter services (London, Kent, Essex or
Surrey/Sussex) then your mortality is equivalent to the US trauma centres.
London is (almost certainly) about to go through regionalisation following
the Darzi report and, with perseverance, hopefully the rest of England &
Wales will follow shortly after.

In the meantime...  :-(

Karim

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
On Behalf Of bensonblues at comcast.net
Sent: 25 November 2007 04:11
To: trauma-list at trauma.org
Subject: Trauma Care in the UK 

Karim,

Even though we Yanks like to be the best, those statistics (ISS>15:  US: 16%
vs UK 30%; ISS>24:  US: 30% vs UK 46%) are hard to understand. I was in
Scotland in '90 and visited the A/E Rooms in Aberdeen, Glasgow, and
Edinburgh, and things seemed to be fine with me. A little different in terms
of who-does-what in the resuscitation bay, but things got done. I wonder if
the comparison takes in account the fact that we see far more penetrating
trauma in the US than the UK? My guess (since I actually drove on the wrong
side of the road for a month while there) is that the bulk of your major
trauma is high-speed vehicular. Severe blunt trauma tends to have
multisystem organ problems that are not as common in penetrating trauma and
that may have pumped up your mortality rate. Maybe we are comparing apples
to oranges?

DB
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