List Archives

Sun Nov 25 14:08:48 GMT 2007

For many people on this list, the essence of the NCEPOD report tells us
nothing that we didn't already know; it is just a way of formalising
"officially" for the government and bring into the public domain these facts
- in the hope that the changes that are necessary can finally be
implemented. I would have made a comment in the same vain as Mike but, as he
put it so eloquently, I'll leave his posting to make the point that I would
have made.

The U.K. is in a strange situation. The NHS (as we know it) cannot continue
to exist due to the failures of government economics and budgeting compared
with the demands placed upon it of the 21st century patient population. The
politicians may well use this report as an excuse to implement a formal
trauma centre system here in the U.K. (which is long overdue), but for the
wrong reasons.

There is no point stating here the reasons for a trauma centre-based system;
we all on this list already know the many reasons for them. As numerous
people have emphasised so far, there is a problem with the delivery,
education and implementation of trauma care here in the U.K. Too many
clinicians involved in trauma care in the U.K. have no interest in trauma
care whatsoever (or at best very little) and/or are not up-to-date with the
latest practice and therefore are not doing the best that is required for
the trauma patient. We can all create Gold Standards of trauma care, but how
to we enforce them??!! If you have an interest in trauma care, they are
self-enforced but others who don't are not properly regulated or cannot be
forced to be educated. To follow Mike's point, there are many "old school"
who, when questioned on the evidence/reasons for their clinical practices
merely respond with "We do it like that because we have always done it that
way!" I thought that the mindset of some who believe that you cannot take a
trauma patient to theatre because he is too unstable had disappeared long
ago!!! (Clearly not!)

It is not rocket science to appreciate that we need a number of specialised
trauma centres here in the U.K. so as to properly manage those with severe
trauma. As both Karim and Tim have stated, you cannot overload specialised
trauma centres for the management of the odd trauma fracture or rib fracture
etc. but nevertheless you do need to have a regular trauma caseload in order
to appropriately manage the complicated patients. If you don't see and do
regularly, you become somewhat deskilled. When you see the management of a
major complicated trauma patient in a DGH, it is clear to see that many of
the "team" (and I am NOT referring to a trauma team here) have no idea how
to manage the patient effectively. [On 1 particular occasion I saw an RTC
patient remain for 9 hours in the resus bay with numerous litres of O neg
blood and fluids infused for intra-thoracic and abdominal bleeding with a
head injury and unstable spine injury. This patient was 26 years old and,
needless to say, the outcome of this patient was catastrophic due to the
numerous deleterious actions of the "team leader." The patient survived as a
tetraplegic and had an irrecoverable hypoxic brain injury and spent many
months on the general ITU/HDU before being transferred to the spinal
injuries centre where he remained for even longer.] THIS CLEARLY HIGHLIGHTS
THE NEED FOR SPECIALISED TRAUMA CENTRES IN THE U.K. Had the patient been
treated in such a specialised trauma centre, his outcome would have been
much better. There is a substantial cost for implementing a national trauma
care system yes...but what about the chronic care cost and QALYS for
patients such as these who survive with severe disability/morbidity as a
result of the failings of the system??!!

I have no doubt that for the UK to establish such a trauma centre care
system would automatically self-select trauma clinicians who have an
interest in trauma care (with the relevant knowledge, skills and up-to-date
education required to manage these patients) to work at these centres. Those
with an interest in trauma would no doubt "migrate" to work for such
institutions; whereas those who do not have such an interest would continue
to work under the auspices of generic hospitals. There is also clearly a
need for locally situated trauma rehabilitation centres so as to enable
recovery without bed-blocking acute care beds in such specialised trauma
centres.

The results of the NCEPOD report, as already referred to, are somewhat
skewed. It reports the average quality of trauma care across the U.K.
Indeed, in some areas (such as in London) the quality of care is fortunately
significantly better than the national average quoted; whereas in others, it
is disappointingly worse. Frustratingly, despite the efforts of experienced
trauma clinicians to improve quality of trauma care in some areas, this has
been prevented by political and egotistical agendas wishing to deny that a
problem exists, rather than openly admitting it so as to work together as a
multi-agency approach and improve the current situation. Thankfully NCEPOD
did publicly highlight these problems. Now we can hopefully address this
issues openly and improve trauma care here in the U.K..

As we all already know, many of the detrimental findings of the NCEPOD
report can be overcome with proper implementation and systematic structuring
of a national trauma care system but, in order to do this, there clearly
needs to be a number of well-motivated people/clinicians with an interest in
trauma care in order to influence and empower that change.

This will certainly be a start....

Matthew

List Archives

For your convenience, find the Trauma List Archive Below

Trauma Care in the UK - Time for change