Clinical Path

 

The clinical pathway for major trauma patients aims to identify those likely to have the most severe injuries and move them through the centres providing specialist care across the region.

Pre-hospital care

Following the 999 call, the ambulance service mobilises a response that might include rapid response vehicles, ambulances, enhanced care teams and/or air ambulances. All pre-hospital clinical staff will apply the regional Trauma Triage Tool within 10minutes of arriving on-scene - aiming to identify candidate major trauma patients.  If a patient triggers any of the points on the Trauma Triage Tool they should, where safe to do so, be taken directly to the regional Major Trauma Centre if they can get there within 45minutes.  Otherwise, the patient is taken to the nearest Trauma Unit.  The pre-hospital clinicians provide immediate care to patients at scene and in-transit to hospital.  A telephone alert call is made to the receiving hospital using a standardised structure.

Acute care

The receiving hospital, on receiving a telephone alert call for a major trauma patient, will activate the Trauma Team to provide immediate assessment and resuscitation to the patient. The Trauma Team is trained (on the Trauma Team Essentials Course) and led by a Team Leader (trained in ATLS/ETC) following TEMPO regional guidelines. Most patients (whether in a Trauma Unit or Major Trauma Centre) will need a CT scan to define their injuries and the necessary care - emergency surgery, interventional radiology, or care on a ward or ITU.

Ongoing care

Hospital care may be from a number of inpatient teams - orthopaedics, general surgery, plastic surgery, ENT, maxillofacial, cardiothoracic etc. Care will often also include psychologists, physiotherapists, occupational therapists, speech and language therapists and many more. During this period, the needs of patients may be able to be met locally and so find that they are transferred from the Major Trauma Centre back to their local Trauma Unit. This also helps family and friends visiting and supporting patients.

Rehabilitation

Very early on, a comprehensive assessment is undertaken of the patient's likely rehabilitation needs. This Rehabilitation Prescription is used by all the teams caring for the patient and is regularly updated. It is personal to the needs of the patient taking into account their activities before the injury occurred and goals for the future. This may well need specialist rehabilitation for the most severely injured. For adults this may be at the Colman Hospital in Norwich, or for those with spinal cord injuries, at either Stoke Mandeville or Sheffield Spinal Cord Injury Centre. This can be a long phase and continues when the patient returns home with he community services.

© 2020 East of England Trauma Network

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