Patients

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 causes of most major trauma are road traffic collisions or falls under 2metres.

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 and in the place that most benefits them.

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 the Major Trauma Centre for adults and children is at Addenbrooke's Hospital, Cambridge.

A Trauma Unit (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 45 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.

If a patient no longer requires the specialist care of the MTC, but still needs some medical care, they may be transferred back to their nearest TU to continue this care whilst undergoing any rehabilitation required.

Whilst there are only a small number of major trauma patients across the region 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 Major Trauma Networks across the NHS in England, 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.

In the East oEngland there were approximately 2,000 major trauma patients during 2018 and on average the MTC will treat four to five people a day.

Patients with a severe injury are assessed by ambulance staff at the scene of the incident. Then, if they are within 45 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.

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 45 minutes and it means patients are treated in a specialist centre with all the facilities and expertise they may need, sooner than before.

​

For major trauma patients, spending a little extra time getting to a hospital which provides the right team of specialists can be 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).

Major trauma in children is thankfully very rare. We are fortunate to have a highly specialised services for the care of critically ill children at the same hospital as for adults.. The initial pathway is the same for children

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