Major Trauma: Local Questions and Answers
Where are Devon and Cornwall’s trauma units?
There are 4 trauma units across the Peninsula which are based at the following General Hospitals:
- North Devon District Hospital, Barnstaple
- Royal Cornwall Hospital, Truro
- Royal Devon and Exeter Hospital, Exeter
- Torbay Hospital, Torquay
Where is my nearest major trauma centre?
The Peninsula Trauma Centre is based at Derriford Hospital, Plymouth and covers all of Devon and Cornwall. A range of information about their major trauma services can be found on the University Hospitals Plymouth website.
How do I get to Derriford Hospital?
What about children?
Derriford Hospital is an adult major trauma centre and all children should go to the nearest children’s major trauma centre in Bristol, at the Bristol Royal Hospital for Children . If your child needs to go there because of their injuries, in the majority of cases they will receive their initial treatment at one of the local Trauma units or at Plymouths adult major trauma centre before being transferred there.
Am I able to stay with my relative at the major trauma centre?
Unless your relative is a child it would not be usual practice for you to be able to stay with them in hospital. Although there maybe exceptions to this.
The Major Trauma Centre Co-ordinators are able to provide support and information for patients and carers. They are contactable on 01752 438350 or via email plh-tr.MTC-Coord@nhs.net
Major Trauma: Questions and Answers
What is major trauma?
Major trauma describes serious and often multiple injuries where there is a strong possibility of death or disability. These might include serious head, chest, abdominal and skeletal injuries sustained as a result of accidents, sport or violence. Major trauma is the main cause of death for people under the age of 45 and is a major cause of debilitating long term injuries. In this region the cause of most major trauma is a fall under 2m. Road traffic collisions are the next biggest cause of major trauma.
What is a Major Trauma Network?
Major trauma networks are organised groups of services and personnel, who serve a defined population and aim to reduce death and disability following injury. The three overlapping phases (pre-hospital, in-hospital and rehabilitation) of a patient's journey require organisation and co-ordination so that patients are treated at the time in the place that most benefits them.
What is a Major Trauma Centre?
A Major Trauma Centre (MTC) is part of a Major Trauma Network. It is a specialist hospital responsible for the care of the most severely injured patients who have suffered major trauma injuries. It provides 24/7 emergency access to consultant-delivered care for a wide range of specialist clinical services and expertise, such as neurosurgery, cardiac and thoracic surgery and specialist orthopaedic surgery. In this region there are two Major Trauma Centres - one for adults and one for children.
What is a Trauma Unit?
A TU is a hospital that is part of the Major Trauma Network providing care for all except the most severely injured major trauma patients. When it is not possible to get to the Major Trauma Centre within 60 minutes, or where the patient needs to be stabilised quickly, they will be taken to the nearest TU for immediate treatment and stabilisation before being transferred on to the MTC.
As the TU's in this region are all district general hospitals, patients with mild to moderate major trauma will often receive all of their care at one of them.
If a patient no longer requires the specialist care of the MTC, but still needs some medical care, they may be repatriated back to their nearest TU to contine this care whilst undergoing any rehabilitation required.
Why did we need to change the way major trauma services are provided?
Whilst there are only a small number of major trauma patients across the Peninsula compared to the overall population, this group of patients have complex injuries and need expert care to ensure they have the best chance of survival and recovery.
Whilst all hospitals with Emergency Departments across England used to treat both adults and children involved in major trauma, good patient outcomes have been lower than in healthcare systems in equivalent western economies (National Audit Office Report, 2010) where Major Trauma Networks are already fully operational, such as the USA and Australia..
With the implementation of a Major Trauma Network, there is a now a much better chance of surviving and recovering from a major trauma injury. Referral pathways from scene to Major Trauma Centre are now much improved and many of the previous delays in the system are gradually being removed. Patients have direct access to specialist teams and state-of-the-art equipment to ensure they receive immediate treatment, 24 hours a day, seven days a week.
How many people suffer major trauma a year?
In the Peninsula there were approximately 2,000 major trauma patients during 2015 and on average the MTC will treat two to three people a day.
What happens to a major trauma patient under the new system?
Patients with a severe injury are assessed by ambulance staff at the scene of the incident. Then, if they are within 60 minutes of the MTC they are taken directly there if it is safe to do so. If the patient needs stabilisation they will be taken to the nearest TU, prior to likely transfer to the MTC. At the major trauma centre, patients are cared for by an on-site team, including experts in diagnostic tests, traumatic injuries and brain surgery. Patients who have less severe major trauma injuries may receive all of their care at their nearest trauma unit.
Will major trauma patients have longer ambulance journey times?
In some cases, patients may have to travel longer in the ambulance to get to a major trauma centre than they would have done previously if they were being taken to their local hospital. However, the journey is unlikely to take longer than 60 minutes and it means patients are treated in a specialist centre with all the facilities and expertise they may need, sooner than before. They will also not then need to be transferred from a local hospital or trauma unit, which would incur delays to treatment and could have adverse effects on survival.
For major trauma patients, spending a little extra time getting to a hospital which provides the right team of specialists is more important than getting to the nearest hospital. Specialist treatment at a major trauma centre has a greater impact than journey time (ie, the time spent in an ambulance) on medical outcomes and can increase survival rates by up to 20 percent (National Audit Office Report, Major Trauma Care in England 2010).
Are major trauma services the same for children as they are for adults?
Major trauma in children is thankfully very rare. We are fortunate in the Peninsula to have a highly specialised hospital in Bristol for the care of critically ill children. The initial system is the same for children with consultant delivered resuscitation at a TU or Adult MTC. A small number of children may then require transfer to Bristol Royal Hospital for Children for ongoing specialist care and rehabilitation.
What are the benefits of having a major trauma network?
The benefits associated with the implementation of a major trauma network are:
- Patient outcomes have improved.
- Mortality rates associated with major trauma are reducing.
- The major trauma network is able to facilitate the establishment of more effective clinical teams.
- The major trauma network is a long-term sustainable service due to it facilitating the reduction of associated costs and more effective use of resources.
My local hospital isn't a major trauma centre / unit - will this affect the level of care a local major trauma patient may get?
No, under the new system all major trauma patients can expect to receive the same high standard of care, regardless of when and where they are when suffering a severe injury. In some cases, patients may have to travel longer in the ambulance to a major trauma centre than they would have done if they were being taken to their local A&E. However, the journey is unlikely to take longer than 60 minutes and it means patients will be treated in a specialist centre with all the facilities and expertise they may need. They will then not need to be transferred from a local hospital or trauma unit, which would incur delays to treatment and could have adverse effects on survival.
When it is not possible to get to a major trauma centre within 60 minutes, patients will be taken to the nearest hospital with a local trauma unit for immediate treatment and stabilisation before being transferred on to a major trauma centre.
For major trauma patients, spending a little extra time getting to a hospital which provides the right team of specialists is more important than getting to the nearest hospital. Specialist treatment at a major trauma centre has a greater impact on journey time (ie the time spent in an ambulance) on medical outcomes and can increase survival rates by 20 percent (National Audit Office Report, Major Trauma Care in England 2010).
With thanks to Thames Valley Trauma Network & Oxford University Hospitals