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.
Following the 999 call, the ambulance service mobilises a response that might include rapid response vehicles, ambulances, enhanced care teams and/or air ambulances. The pre-hospital clinicians provide immediate care to patients at scene and in-transit to hospital. All pre-hospital clinical staff will apply the regional Trauma Triage Tool - 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 to resuscitate and provide expert triage. A telephone alert call is made to the receiving hospital using a standardised structure.
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, trained on the Trauma Team Essentials Course, led by a Team Leader, trained in ATLS/ETC, follow 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.
Hospital care may be led by 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 phase of care, it may be possible to meet the needs of the patient locally, and they will therefore be transferred from the MTC back to their local TU. This also helps family and friends visiting and supporting patients.
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. The most severely injured patients may need specialist rehabilitation. 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 continuing with the community services when the patient returns home .