The Reconstructive Trauma Surgery Interface Fellowship and its applicability to military and civilian trainees

2018 ◽  
Vol 164 (5) ◽  
pp. 360-361 ◽  
Author(s):  
Douglas Hammond ◽  
J Breeze ◽  
D Evriviades
Keyword(s):  
Surgical Training ◽  
Major Trauma ◽  
Complex Trauma ◽  
Trauma Surgery ◽  
Queen Elizabeth Hospital ◽  
Trauma Patients ◽  
Multidisciplinary Management ◽  
Leadership Experience ◽  
The Uk ◽  
The Military

The Reconstructive Trauma Surgery Fellowship is a based at the Queen Elizabeth Hospital, Birmingham, and focuses on the multidisciplinary management of major trauma from presentation to discharge. It is unique to the UK in that it provides both management and leadership experience as well as operative surgical skills particularly in terms of reconstruction on complex trauma patients including those from the military. This paper describes the relevance of fellowships in modern surgical training, composition of the reconstructive trauma fellowship and the relevance for both civilian and military trainees.

scholarly journals (A39) Civil-Military Collaboration in Trauma Training

2011 ◽  
Vol 26 (S1) ◽  
pp. s11-s12
Author(s):  
L. Lundberg ◽  
P. Ortenwall
Keyword(s):  
Major Trauma ◽  
Trauma Surgery ◽  
Armed Forces ◽  
Medical Personnel ◽  
Health Staff ◽  
Surgical Trauma ◽  
Trauma Patients ◽  
Military Health ◽  
Medical Organisation ◽  
The Military

In the present Swedish military medical organisation all medical personnel, including surgeons, have to be recruited from civilian hospitals. Even if there are many civilian surgeons well qualified to perform trauma surgery, the injury patterns seen in e.g. Afghanistan are quite different compared to what is generally seen in trauma patients arriving to the ED at a civilian hospital. In order to upgrade the major trauma skills of the civilian surgeons recruited to and trained for participating in international missions, the (extended) military version of the Definitive Surgical Trauma Care (DSTC) Course has been implemented. DSTC is given with the intention not to duplicate ATLS, nor to provide an in depth course in surgery, but rather to teach those techniques particularly applicable to the patient who requires surgery and intensive care for major trauma, in a setting where such care is not commonly practised or even necessarily available. The course, made up by a mix of lectures, case discussions and skill stations has been given at the Swedish Armed Forces Centre for Defence Medicine in Gothenburg since 2007. It has gradually evolved to incorporate also anaesthesiologists and nursing staff into an integrated team. The faculty during these courses has been made up by a mix of international and Swedish instructors. Course candidates have primarily been military health staff, but vacant slots have been offered clinicians working in civilian hospitals in the western part of Sweden. During the last course in September 2010 17/20 (85%) of the physicians and 13/17 (76%) of the nurses rated the course as very beneficial or indispensible. The Swedish Armed Forces Centre for Defence Medicine will continue to run the military version of the DSTC course. Due to a certain over-capacity, course participation can be offered the civilian health care system.

scholarly journals Military General Surgical Training Opportunities on Operations in Afghanistan

2009 ◽  
Vol 91 (5) ◽  
pp. 417-419 ◽  
Author(s):  
Adam J Brooks ◽  
Arul Ramasamy ◽  
David Hinsley ◽  
Mark Midwinter
Keyword(s):  
Surgical Management ◽  
Surgical Training ◽  
Trauma Surgery ◽  
Organ Injury ◽  
Surgical Trauma ◽  
Training Opportunity ◽  
Injury Management ◽  
Surgical Trainees ◽  
Specific Organ ◽  
The Uk

INTRODUCTION In the UK, general surgical specialist trainees have limited exposure to general surgical trauma. Previous work has shown that trainees are involved in only two blunt and one penetrating trauma laparotomies per annum. During their training, nearly half of trainees will not be involved in the surgical management of liver injury, 20% will not undertake a trauma splenectomy and only a quarter will see a trauma thoracotomy. Military general surgical trainees require training in, and exposure to, the surgical management of trauma and specifically military wounding patterns that is not available in the UK. The objective of this study was to determine whether operative workload in the sole British surgical unit in Helmand Province, Afghanistan (Operation HERRICK) would provide a training opportunity for military general surgical trainees. PATIENTS AND METHODS A retrospective theatre log-book review of all surgical cases performed at the Role 2 (Enhanced) treatment facility at Camp Bastion, Helmand Province on Operation HERRICK between October 2006 and October 2007, inclusive. Operative cases were analysed for general surgical trauma, laparotomy, thoracotomy, vascular trauma and specific organ injury management where available. RESULTS A total of 968 operative cases were performed during the study period. General surgical procedures included 51 laparotomies, 17 thoracotomies and 11 vascular repairs. There were a further 70 debridements of general surgical wounds. Specific organ management included five cases of liver packing for trauma, five trauma splenectomies and four nephrectomies. CONCLUSIONS A training opportunity currently exists on Operation HERRICK for military general surgical specialist trainees. If the tempo of the last 12 months is maintained, a 2-month deployment would essentially provide trainees with the equivalent trauma surgery experience to the whole of their surgical training in the UK NHS. Trainees would gain experience in military trauma as well as specific organ injury management.

Multidisciplinary Management of Severe Traumatic Hepatic Injury Involving Interventional Radiology Embolization, Trauma Laparotomy, and Liver Transplantation

2021 ◽  
pp. 000313482110318
Author(s):  
Jigesh Shah ◽  
Arjmand Mufti ◽  
Ryan Dumas ◽  
Matthew Porembka ◽  
Joseph Minei ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Interventional Radiology ◽  
Hepatic Injury ◽  
Trauma Surgery ◽  
Normal Activity ◽  
Trauma Patients ◽  
Multidisciplinary Management ◽  
Early Return ◽  
Definitive Therapy ◽  
Transplant Evaluation

This report describes liver transplantation as a successful strategy in the management of a young man who presented to a local emergency room following catastrophic traumatic hepatic vascular injuries. Expeditious multidisciplinary management, including interventional radiology, trauma surgery, and ultimately transplant surgery, provided the patient with definitive therapy following his injuries and early return to normal activity. Our experience highlights the importance of prompt referral of select hepatic trauma patients for liver transplant evaluation as part of their complex trauma management.

scholarly journals Demystifying damage control in musculoskeletal trauma

2016 ◽  
Vol 98 (5) ◽  
pp. 291-294 ◽  
Author(s):  
P Bates ◽  
P Parker ◽  
I McFadyen ◽  
I Pallister
Keyword(s):  
Large Scale ◽  
Major Trauma ◽  
Damage Control ◽  
Trauma Surgery ◽  
Major Surgery ◽  
Surgical Trauma ◽  
Trauma Patients ◽  
Appropriate Care ◽  
Fracture Management ◽  
Early Appropriate Care

Trauma care has evolved rapidly over the past decade. The benefits of operative fracture management in major trauma patients are well recognised. Concerns over early total care arose when applied broadly. The burden of additional surgical trauma could constitute a second hit, fuelling the inflammatory response and precipitating a decline into acute respiratory distress syndrome, sepsis and multiple organ dysfunction syndrome. Temporary external fixation aimed to deliver the benefits of fracture stabilisation without the risk of major surgery. This damage control orthopaedics approach was advocated for those in extremis and a poorly defined borderline group. An increasing understanding of the physiological response to major trauma means there is now a need to refine our treatment options. A number of large scale retrospective reviews indicate that early definitive fracture fixation is beneficial in the majority of major trauma patients. It is recommended that patients are selected appropriately on the basis of their response to resuscitation. The hope is that this approach (dubbed ‘safe definitive fracture surgery’ or ‘early appropriate care’) will herald an era when care is individualised for each patient and their circumstances. The novel Damage Control in Orthopaedic Trauma Surgery course at The Royal College of Surgeons of England aims to equip senior surgeons with the insights and mindset necessary to contribute to this key decision making process as well as also the technical skills to provide damage control interventions when needed, relying on the improved techniques of damage control resuscitation and advances in the understanding of early appropriate care.

Relationship between the Injury Severity Score and the need for life-saving interventions in trauma patients in the UK

2020 ◽  
pp. emermed-2019-209092
Author(s):  
James Vassallo ◽  
Gordon Fuller ◽  
Jason E Smith
Keyword(s):  
Injury Severity Score ◽  
Severity Score ◽  
Major Trauma ◽  
Injury Severity ◽  
Research Network ◽  
Trauma Patients ◽  
Traditional Definition ◽  
Life Saving ◽  
Clinically Significant ◽  
The Uk

IntroductionMajor trauma is the third leading cause of avoidable mortality in the UK. Defining which patients require care in a major trauma centre is a critical component of developing, evaluating and enhancing regional major trauma systems. Traditionally, trauma patients have been classified using the Injury Severity Score (ISS), but resource-based criteria have been proposed as an alternative. The aim of this study was to investigate the relationship between ISS and the use of life-saving interventions (LSI).MethodsRetrospective cohort study using the Trauma Audit Research Network database for all adult patients (aged ≥18 years) between 2006 and 2014. Patients were categorised as needing an LSI if they received one or more interventions from a previously defined list determined by expert consensus.Results193 290 patients met study inclusion criteria: 56.9% male, median age 60.0 years (IQR 41.2–78.8) and median ISS 9 (IQR 9–16). The most common mechanism of injury was falls <2 m (52.1%), followed by road traffic collisions (22.2%). 15.1% received one or more LSIs. The probability of a receiving an LSI increased with increasing ISS, but only a low to moderate correlation was evident (0.334, p<0.001). A clinically significant number of cases (5.3% and 7.6%) received an LSI despite having an ISS ≤8 or <15, respectively.ConclusionsA clinically significant number of adult trauma patients requiring LSIs have an ISS below the traditional definition of major trauma. The traditional definition should be reconsidered and either lowered, or an alternative metric should be used.

Establishing a legal service for major trauma patients at a major trauma centre in the UK

2017 ◽  
Vol 34 (9) ◽  
pp. 606-607 ◽  
Author(s):  
William H Seligman ◽  
Julian Thompson ◽  
Hannah E Thould ◽  
Charlotte Tan ◽  
Andrew Dinsmore ◽  
...  
Keyword(s):  
Major Trauma ◽  
Trauma Centre ◽  
Legal Service ◽  
Trauma Patients ◽  
Major Trauma Centre ◽  
The Uk

Pattern of injuries and management of adolescent trauma in a combined adult and paediatric major trauma centre in United Kingdom

Trauma ◽  
2020 ◽  
pp. 146040862092170
Author(s):  
Fahim Anwar ◽  
Harry Mee ◽  
Judith Allanson ◽  
Elly Mendis ◽  
Colin Hamilton
Keyword(s):  
Young People ◽  
Major Trauma ◽  
Motor Vehicle ◽  
Survival Rates ◽  
Trauma Centre ◽  
Trauma Patients ◽  
Retrospective Case ◽  
Adult Intensive Care Unit ◽  
Major Trauma Centre ◽  
The Uk

Background Major trauma is a leading cause of death and disability in 16–18-year olds in the UK. Since the launch of major trauma centres (MTCs) in 2012 in UK, survival rates have improved on the whole. The aim of this study was to look at the pathways of 16–18-year olds through one MTC and patterns of rehabilitation provision. Material and methods A retrospective case notes review of all trauma patients aged between 16 and 18 years admitted to one MTC between October 2012 and May 2018. Results One hundred forty-seven young people were identified. 67.3% were male with a mean age of 17.1 years. Motor vehicle accidents were the most common cause of injury (59.2%). Thirty-nine percent had a Glasgow Coma Scale at scene >13. Sixty-three percent were admitted to an adult intensive care unit (ICU), 5.4% to paediatric ICU and 31.3% directly to a ward. Admissions to rehabilitation ward came through adult services with no commissioned equivalent in those admitted to paediatrics. Mean length of stay was 18.1 days. 75.5% of patients were discharged home from the MTC. Discussion The majority of young people were admitted on to adult wards and were able to access commissioned services. However, such services do not provide for the specialist needs of young people, with no access to schooling or parent’s accommodation. Those who were admitted to children’s services missed out on commissioned rehabilitation pathways. Conclusion Young people of transition age often fall between services. For the first time, we illustrate injury patterns and the fragmented services seen in this vulnerable patient group.

Major Trauma

2011 ◽  
Author(s):  
Pawan Gupta
Keyword(s):  
High Speed ◽  
Major Trauma ◽  
Trauma Team ◽  
Vital Role ◽  
Trauma Patients ◽  
Ambulance Personnel ◽  
Mortality And Morbidity ◽  
Resuscitation Room ◽  
The Difference ◽  
The Uk

In the UK, trauma is currently the commonest cause of death in people <40 years and its incidence is predicted to rise over the next 20 years. So you have an important role in the assessment and management of this group of patients. Doctors of the ED perform a vital role in the early stages of management of trauma patients. In patients with multiple injuries, the care is delivered by a trauma team constituted by middle-grade doctors from various specialties. A senior doctor, usually from the ED and with training in dealing with trauma, leads the team. The trauma team is often requested by the prehospital ambulance personnel, but this is not always the case. Although in your first few days you would not be expected to manage such situations on your own, you may come across a patient with serious trauma behind the curtains in a cubicle. Recognizing the seriousness of the situation and calling for help in the form of a trauma team may make all the difference to that patient in terms of recovery. The principles of assessment and management of trauma patients are discussed in the first answer of this chapter. The ATLS course introduces you to the principles of early management of trauma victims and this can be applied to any trauma patient whom you will see in the ED. The skills you learn on the ATLS course are applicable in many situations. It is advisable to attend this training course while you are working in the ED. You should suspect major trauma in the following situations: • Related to vehicles: high-speed collisions, victim’s ejection from the vehicle (partial or total), rollover, prolonged extrication, etc. • Death of a co-passenger • Pedestrians run over or thrown away to a distance, or with a significant impact (>20mph/32kph) • Falls from a height of >6m in adults and >3m in children or two to three times the height of the child. Resuscitation in the first hour in the resuscitation room has been proved to reduce mortality and morbidity among trauma patients, and so it might be you who will have saved the life of an individual.

1 Simultaneous trauma patients in emergency departments: a difference in mortality?

2018 ◽  
Vol 164 (3) ◽  
pp. 224.1-224
Author(s):  
L Morrow ◽  
T Nutbeam ◽  
O Bouamra
Keyword(s):  
Emergency Department ◽  
Patient Outcomes ◽  
Major Trauma ◽  
Injury Severity ◽  
Research Network ◽  
Trauma Patients ◽  
Icu Stay ◽  
Patient Category ◽  
The Uk ◽  
The Impact

BackgroundThe presentation of multiple simultaneous trauma patients to an Emergency Department is likely to place significant stress and strain on trauma care resources. Currently there is limited literature and no UK or multicentre data available to understand this impact. The aim of this study was to identify patient outcomes when there are simultaneous major trauma patients. We hypothesised that with increasing numbers of simultaneous trauma patients an increase in mortality may be seen.MethodsThe Trauma Audit and Research Network (TARN) database was interrogated from 2010–2015 to identify simultaneous major trauma patients. We defined simultaneous trauma as occurring when there was more than one trauma patient within an Emergency Department at any one time.Patient age, sex, Glasgow Coma Scale and Injury Severity Score (ISS) were recorded. A standardised comparison using a stratified Ws statistic was conducted to compare mortality between groups. Secondary outcomes included length of hospital and intensive care (ICU) stay.ResultsOf 2 07 094 patients, 33.7% were eligible simultaneous trauma patients. 55.7% of patients were male, median age was 61 and median ISS was 9. No increase in mortality was seen with increasing patient numbers (table 1).Abstract 1 Table 1 Ws statistic with increasing simultaneous patient numbersIsolated2 patients3 patients4 patients5 patients6+patientsTotal1 37 360 51 466 13 820 3539 671 185 Ws statistic0.05 0.38 0.72 0.53 0.39 2.70 A statistically significant increase in length of ICU stay was observed for the 6+patient category (p=0.047) but no difference was reported in hospital stay.ConclusionThe impact of simultaneous trauma patients on patient outcomes within the UK has not been previously defined. Simultaneous trauma patients do not appear to have an impact on mortality (as measured by Ws statistic).

scholarly journals 118 Trauma in COVID-19: A comparison analysis of trauma calls at a Major Trauma Centre in the UK during the CoVID pandemic restrictions

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
S Naseem ◽  
J Lee
Keyword(s):  
Major Trauma ◽  
Road Traffic ◽  
Fold Increase ◽  
Trauma Centre ◽  
Trauma Patients ◽  
Deliberate Self Harm ◽  
Trauma Service ◽  
Major Trauma Centre ◽  
Self Harm ◽  
The Uk

Abstract Aim Varying restrictions placed on the UK public to manage the COVID-19 Pandemic impacted on the day-to-day lives of most people and changed the presentation and nature of trauma presenting at our UK Major Trauma Centre. Trauma activity during the November and March 2020 lockdown periods were compared and the changes in trauma activity were used to inform workforce planning. During the most restrictive period, March 2020, trauma activity initially decreased compared with 6 weeks preceding lockdown, before returning and then exceeding beyond pre-lockdown levels. Method Prospective data was collected for all ED trauma calls and regional referrals to the Major Trauma Service. We compared the initial 27-day lockdown periods in November to March 2020; specifically comparing trends in code red calls, silver trauma, road traffic collisions and injuries resulting from deliberate self-harm. Results There were a similar number of RTCs (18 vs 16) in both periods. There was a 28% increase in the number of trauma calls (103 vs 80), and a 4-fold increase in Code RED calls (8 vs 2) and injuries due to deliberate self-harm (8 vs 2). There were almost double the number of silver trauma patients. Interestingly, there was a 30% decrease in alcohol related trauma alerts. Conclusions Our results reflected the level of restrictions in place; a higher incidence of trauma calls including code reds and RTCs in November. The higher incidence of self-harm noticed in the second lockdown may reflect the psychological impact of the pandemic and change in restrictions over time.

Sign in / Sign up

Export Citation Format

Share Document