A national plan for trauma services

2007 ◽  
Vol 89 (9) ◽  
pp. 306-307
Author(s):  
John Stanley ◽  
Jo Cripps
Keyword(s):  
Trauma Care ◽  
Critical Examination ◽  
National Plan ◽  
David Cameron ◽  
General Hospitals ◽  
Trauma Centres ◽  
Injured Patients ◽  
Service Change ◽  
Service Closure

The reconfiguration debate has dominated the NHS over the summer with Conservative leader David Cameron promising a 'bare knuckle fight' over district general hospitals under threat from service closure. With the focus clearly on the need for service change, it is timely for the College to restate its policy on the provision of trauma care. We are calling for a critical examination of those centres currently providing trauma care and a national plan for the identification of major specialist trauma centres to provide the best care to injured patients.

scholarly journals Models of care for traumatically injured patients at trauma centres in British Columbia: variability and sustainability

CJEM ◽  
2017 ◽  
Vol 20 (2) ◽  
pp. 200-206 ◽  
Author(s):  
Benjamin Tuyp ◽  
Kasra Hassani ◽  
Lisa Constable ◽  
Joseph Haegert
Keyword(s):  
Trauma Care ◽  
Trauma System ◽  
Models Of Care ◽  
Short Stay ◽  
Trauma Centres ◽  
Trauma Unit ◽  
Trauma Service ◽  
Level Ii ◽  
Level I ◽  
Injured Patients

AbstractBackgroundSuccessful trauma systems employ a network of variably-resourced hospitals, staffed by experienced providers, to deliver optimal care for injured patients. The “model of care”—the manner by which inpatients are admitted and overseen, is an important determinant of patient outcomes.ObjectivesTo describe the models of inpatient trauma care at British Columbia’s (BC’s) ten adult trauma centres, their sustainability, and their compatibility with accreditation guidelines.MethodsQuestionnaires were distributed to the trauma medical directors at BC’s ten Level I-III adult trauma centres. Follow-up semi-structured interviews clarified responses.ResultsThree different models of inpatient trauma care exist within BC. The “admitting trauma service” was a multidisciplinary team providing exclusive care for injured patients. The “on-call consultant” assisted with Emergency Department (ED) resuscitation before transferring patients to a non-trauma admitting service. The single “short-stay trauma unit” employed on-call consultants who also oversaw a 48-hour short-stay ward.Both level I trauma centres utilized the admitting trauma service model (2/2). All Level II sites employed an on-call consultant model (3/3), deviating from Level II trauma centre accreditation standards. Level III sites employed all three models in similar proportions. None of the on-call consultant sites believed their current care model was sustainable. Inadequate compensation, insufficient resources, and difficulty recruiting physicians were cited barriers to sustainability and accreditation compliance.ConclusionsThree distinct models of care are distributed inconsistently across BC’s Level I-III trauma hospitals. Greater use of admitting trauma service and short-stay trauma unit models may improve the sustainability and accreditation compliance of our trauma system.

scholarly journals The evolution of trauma care in the Netherlands over 20 years

2019 ◽  
Vol 46 (2) ◽  
pp. 329-335 ◽  
Author(s):  
Falco Hietbrink ◽  
Roderick M. Houwert ◽  
Karlijn J. P. van Wessem ◽  
Rogier K. J. Simmermacher ◽  
Geertje A. M. Govaert ◽  
...  
Keyword(s):  
The Netherlands ◽  
Trauma Care ◽  
Trauma System ◽  
Trauma Surgeon ◽  
Severely Injured ◽  
Severely Injured Patients ◽  
The Past ◽  
Level 1 ◽  
Trauma Surgeons ◽  
Injured Patients

Abstract Introduction In 1999 an inclusive trauma system was initiated in the Netherlands and a nationwide trauma registry, including all admitted trauma patients to every hospital, was started. The Dutch trauma system is run by trauma surgeons who treat both the truncal (visceral) and extremity injuries (fractures). Materials and Methods In this comprehensive review based on previous published studies, data over the past 20 years from the central region of the Netherlands (Utrecht) was evaluated. Results It is demonstrated that the initiation of the trauma systems and the governance by the trauma surgeons led to a region-wide mortality reduction of 50% and a mortality reduction for the most severely injured of 75% in the level 1 trauma centre. Furthermore, major improvements were found in terms of efficiency, demonstrating the quality of the current system and its constructs such as the type of surgeon. Due to the major reduction in mortality over the past few years, the emphasis of trauma care evaluation shifts towards functional outcome of severely injured patients. For the upcoming years, centralisation of severely injured patients should also aim at the balance between skills in primary resuscitation and surgical stabilization versus longitudinal surgical involvement. Conclusion Further centralisation to a limited number of level 1 trauma centres in the Netherlands is necessary to consolidate experience and knowledge for the trauma surgeon. The future trauma surgeon, as specialist for injured patients, should be able to provide the vast majority of trauma care in this system. For the remaining part, intramural, regional and national collaboration is essential

scholarly journals The impact of regionalized trauma care on the distribution of severely injured patients in the Netherlands

2021 ◽  
Author(s):  
Suzan Dijkink ◽  
Erik W. van Zwet ◽  
Pieta Krijnen ◽  
Luke P. H. Leenen ◽  
Frank W. Bloemers ◽  
...  
Keyword(s):  
The Netherlands ◽  
Trauma Care ◽  
Trauma System ◽  
Future Research ◽  
Severely Injured ◽  
Trauma Centers ◽  
Severely Injured Patients ◽  
The Right ◽  
Injured Patients ◽  
The Impact

Abstract Background Twenty years ago, an inclusive trauma system was implemented in the Netherlands. The goal of this study was to evaluate the impact of structured trauma care on the concentration of severely injured patients over time. Methods All severely injured patients (Injury Severity Score [ISS] ≥ 16) documented in the Dutch Trauma Registry (DTR) in the calendar period 2008–2018 were included for analysis. We compared severely injured patients, with and without severe neurotrauma, directly brought to trauma centers (TC) and non-trauma centers (NTC). The proportion of patients being directly transported to a trauma center was determined, as was the total Abbreviated Injury Score (AIS), and ISS. Results The documented number of severely injured patients increased from 2350 in 2008 to 4694 in 2018. During this period, on average, 70% of these patients were directly admitted to a TC (range 63–74%). Patients without severe neurotrauma had a lower chance of being brought to a TC compared to those with severe neurotrauma. Patients directly presented to a TC were more severely injured, reflected by a higher total AIS and ISS, than those directly transported to a NTC. Conclusion Since the introduction of a well-organized trauma system in the Netherlands, trauma care has become progressively centralized, with more severely injured patients being directly presented to a TC. However, still 30% of these patients is initially brought to a NTC. Future research should focus on improving pre-hospital triage to facilitate swift transfer of the right patient to the right hospital.

scholarly journals An inventory of Canadian trauma systems: opportunities for improving access to trauma care

CJEM ◽  
2014 ◽  
Vol 16 (03) ◽  
pp. 207-213 ◽  
Author(s):  
Christopher C.D. Evans ◽  
J.M. Tallon ◽  
Jennifer Bridge ◽  
Avery B. Nathens
Keyword(s):  
Trauma Care ◽  
System Development ◽  
Trauma System ◽  
Mail Survey ◽  
Trauma Systems ◽  
Trauma Centres ◽  
Improved Outcomes ◽  
System Components ◽  
Trauma Surgeons ◽  
Future Work

ABSTRACT Objective: Despite evidence that patients suffering major traumatic injuries have improved outcomes when cared for within an organized system, the extent of trauma system development in Canada is limited. We sought to compile a detailed inventory of trauma systems in Canada as a first step toward identifying opportunities for improving access to trauma care. Methods: We distributed a nationwide online and mail survey to stakeholders intended to evaluate the extent of implementation of specific trauma system components. Targeted stakeholders included emergency physicians, trauma surgeons, trauma program medical directors and program managers, prehospital providers, and decision makers at the regional and provincial levels. A “snowball” approach was used to expand the sample base of the survey. Descriptive statistics were generated to quantify the nature and extent of trauma system development by region. Results: The overall response rate was 38.7%, and all levels of stakeholders and all provinces/territories were represented. All provinces were found to have designated trauma centres; however, only 60% were found to have been accredited within the past 10 years. Components present in 50% or fewer provinces included an inclusive trauma system model, interfacility transfer agreements, and a mechanism to track bed availability within the system. Conclusion: There is significant variability in the extent of trauma system development in Canada. Although all provinces have designated trauma centres, opportunities exist in many systems to implement additional components to improve the inclusiveness of care. In future work, we intend to quantify the strength of the relationship between different trauma system components and access to definitive trauma care.

Opportunities for improved trauma care of the elderly – A single center analysis of 2090 severely injured patients

2012 ◽  
Vol 55 (3) ◽  
pp. 660-666 ◽  
Author(s):  
Amadéa Schönenberger ◽  
Adrian T. Billeter ◽  
Burkhardt Seifert ◽  
Valentin Neuhaus ◽  
Otmar Trentz ◽  
...  
Keyword(s):  
Trauma Care ◽  
The Elderly ◽  
Severely Injured ◽  
Single Center ◽  
Severely Injured Patients ◽  
Injured Patients

scholarly journals Trauma 2021Perceptions of a trauma team regarding in situ simulationEpidemiology of submersion injuries in Canadian children and adolescents: 1990–2018A survey of medical and administrative directors on REBOA use in Canadian trauma centresCut to the chase: comparing cutting tools in the exposure of simulated trauma patientsPediatric major trauma. Anaesthesia education: airway, breathing, coffee and cases 2020–2021Geriatric trauma care at a level 1 trauma centre: Are we following best practice?Was the introduction of a provincially standardized consensus statement for postintubation analgesia and sedation associated with increased use of associated pharmacological therapies in New Brunswick?Are there important variations in the care of adult trauma patients with isolated, nonoperative subdural hematomas between those admitted to a neurosurgical centre and those admitted to a non-neurosurgical centre for their entire inpatient stay?Flattening the curve on the negative psychosocial impact of trauma on the family of acute care trauma survivors: a quantitative studyDoes ACLS belong in ATLS? Seeking evidence during resuscitative thoracotomyAutologous omental harvest for microvascular free flap reconstruction of a severe traumatic scalp degloving injury: a case reportDerivation and validation of actionable quality indicators targeting reductions in complications for injury admissionsASA dosing practices in the management of blunt cerebrovascular injury: a retrospective reviewA retrospective analysis of bicycle lane collisions in Vancouver, British Columbia, from 2012 to 2017Evaluating the Screening, Brief Intervention and Referral to Treatment (SBIRT) process at Vancouver General HospitalAlcohol use and trauma in Alberta after COVID-19 lockdown: overrepresentation and undertreatment are opportunities for improvementMental health and addiction diagnoses are linked to increased violent injuries and gaps in provision of resources during the COVID-19 pandemicPain management strategies after orthopedic trauma in a level 1 trauma centre: a descriptive study with a view of optimizing practicesStudy to Actively Warm Trauma Patients (STAY WARM): a feasibility pilot evaluationPrehospital trauma care in civilian and military settings including cold environments: a systematic review and knowledge gap analysisAntibiotic administration in open fractures: adherence to guidelines at a Canadian trauma centreAre we meeting massive transfusion protocol activation and blood product delivery times in trauma patients? A retrospective review from 2014 to 2018Unplanned returns to the operating room: a quality improvement initiative at a level 1 trauma centreStopping the bleed: the history and rebirth of Canadian freeze-dried plasmaThe state of the evidence for emergency medical services (EMS) care of prehospital severe traumatic brain injury: an analysis of appraised research from the Prehospital Evidence-based Practice programA mixed methods study of a paramedic falls referral program in Nova ScotiaFirst presentations of psychiatric illness at a level 1 trauma centreAlcohol and substance abuse screening in pediatric trauma patients: examining rates of screening and implementing a screen for the pediatric populationMeasuring behavioural quality and quantity of team leaders during simulated interprofessional trauma careImproving rural trauma outcomes: a structured trauma-training program for rural family physicians with enhanced surgical skills — a pilot projectTrauma treatment: evidence-based response to psychological needs after a natural disasterHow prepared are Canadian trauma centres for mass casualty incidents?The catalytic effect of multisource feedback for trauma teams: a pilot studyRetrievable inferior vena cava filter for primary prophylaxis of pulmonary embolism in at-risk trauma patients: a feasibility trialValue of data collected by the medical examiner service on the quality of alcohol and toxicology testing in fatal motor vehicle collisionsPrehospital narrow pulse pressure predicts need for resuscitative thoracotomy and emergent surgical intervention after traumaImpact of a geriatric consultation service on outcomes in older trauma patients: a retrospective pre–post studyExploring physical literacy as a condition of fall mechanism in older adultsIs the use of business intelligence software helpful in planning injury prevention campaigns?Exposure to endotracheal intubation among trauma patients in level 5 trauma centres in New Brunswick — a retrospective reviewAre early specialist consultations helpful predictors of those who require care in level 1 or 2 designated trauma centres?Neurologic outcomes after traumatic cardiac arrest: a systematic reviewClosed-loop communication in the trauma bay: identifying opportunities for team performance improvement through a video review analysisEmbolization in nonsplenic trauma: outcomes at a Canadian trauma hospitalThe matrix: grouping ICD-10-CA injury codes by body region and nature of injury for reporting purposesEvaluation of low-value clinical practices in acute trauma care: a multicentre retrospective studyTrauma 101: a virtual case-based trauma conference as an adjunct to medical educationPhysiologic considerations, indications and techniques for ECLS in trauma: experience of a level 1 trauma centreEngaging patients in the selection of trauma quality indicatorsStrategies aimed at preventing chronic opioid use in trauma and acute care surgery: a scoping reviewAugmented reality surgical telementoring for leg fasciotomyIdentification of high-risk trauma patients requiring major interventions for traumatic hemorrhage: a prospective study of clinical gestaltEvaluating best practices in trauma care of older adultsBetween paradigms: comparing patient and parent experiences of injured adolescents treated at pediatric or adult trauma centresEarly outcomes after implementation of chest trauma management protocol in Vancouver General HospitalUtility of diagnostic peritoneal lavage versus focused abdominal sonography for trauma in penetrating abdominal injuryTime to definitive surgery and survival in pediatric patients younger than 18 years with gunshot woundsThe effect of chronic obstructive lung disease on post-traumatic acute respiratory distress syndrome: predictors of morbidity and mortalityThe association between injury type and clinical outcomes in patients with traumatic renal injury after nephrectomyWhen low complication rates are a bad sign: the negative impact of introducing an electronic medical record on TQIP data completenessClinical handover from paramedic services to the trauma team: a video review analysis of the IMIST-AMBO protocol implementationGeriatric Recovery and Enhancement Alliance in Trauma (GREAT) multidisciplinary quality improvement initiative: improving process and outcome measures for geriatric trauma patientsIncreasing the safety of inadvertent iliac artery device deployment with the COBRA-OS, a novel low-profile REBOA deviceIs it better to watch before or listen while doing? A randomized trial of video-modelling versus telementoring for out-of-scope tube thoracostomy insertion performed by search and rescue medicsIndications for prehospital civilian tourniquet application by first responders: an expert consensus opinion of military physicians by the Delphi method

2021 ◽  
Vol 64 (5 Suppl 1) ◽  
pp. S37-S64
Author(s):  
Olga Bednarek ◽  
Mike O’Leary ◽  
Sean Hurley ◽  
Caleb Cummings ◽  
Ruth Bird ◽  
...  
Keyword(s):  
New Brunswick ◽  
Trauma Care ◽  
Trauma Team ◽  
Trauma Centre ◽  
Quality Improvement Initiative ◽  
Evidence Based ◽  
Trauma Patients ◽  
Trauma Outcomes ◽  
Trauma Centres ◽  
Level 1

scholarly journals Effectiveness of trauma centre verification: a systematic review and meta-analysis

2021 ◽  
Vol 64 (1) ◽  
pp. E25-E38
Author(s):  
Brice Batomen ◽  
Lynne Moore ◽  
Mabel Carabali ◽  
Pier-Alexandre Tardif ◽  
Howard Champion
Keyword(s):  
Systematic Review ◽  
Adverse Events ◽  
Resource Use ◽  
Meta Analysis ◽  
The United States ◽  
Trauma Centre ◽  
Trauma Centres ◽  
Processes Of Care ◽  
Injured Patients ◽  
The Impact

Background: There is a growing trend toward verification of trauma centres, but its impact remains unclear. This systematic review aimed to synthesize available evidence on the effectiveness of trauma centre verification. Methods: We conducted a systematic search of the CINAHL, Embase, HealthStar, MEDLINE and ProQuest databases, as well as the websites of key injury organizations for grey literature, from inception to June 2019, without language restrictions. Our population consisted of injured patients treated at trauma centres. The intervention was trauma centre verification. Comparison groups comprised nonverified trauma centres, or the same centre before it was first verified or re-verified. The primary outcome was in-hospital mortality; secondary outcomes included adverse events, resource use and processes of care. We computed pooled summary estimates using random-effects meta-analysis. Results: Of 5125 citations identified, 29, all conducted in the United States, satisfied our inclusion criteria. Mortality was the most frequently investigated outcome (n = 20), followed by processes of care (n = 12), resource use (n = 12) and adverse events (n = 7). The risk of bias was serious to critical in 22 studies. We observed an imprecise association between verification and decreased mortality (relative risk 0.74, 95% confidence interval 0.52 to 1.06) in severely injured patients. Conclusion: Our review showed mixed and inconsistent associations between verification and processes of care or patient outcomes. The validity of the published literature is limited by the lack of robust controls, as well as any evidence from outside the US, which precludes extrapolation to other health care jurisdictions. Quasiexperimental studies are needed to assess the impact of trauma centre verification. Systematic reviews registration: PROSPERO no. CRD42018107083

Imaging Evaluation in the Early Management of Severely Injured Patients.

2021 ◽  
Author(s):  
Christopher Spering ◽  
Soehren Dirk Brauns ◽  
Bertil Bouillon ◽  
Mark-Tilmann Seitz ◽  
Katharina Jaeckle ◽  
...  
Keyword(s):  
Vascular Injury ◽  
Thoracic Trauma ◽  
Severely Injured ◽  
Severely Injured Patients ◽  
Initial Management ◽  
Trauma Centres ◽  
Therapeutic Consequences ◽  
Time Period ◽  
Injured Patients

Abstract Introduction: The plain film chest x-ray in supine position (CXR) during the initial management of severely injured patients has almost lost its clinical relevance, since it has been challenged by extended focused assessment with sonography in trauma (eFAST) in early trauma management, due to its superiority in detecting a pneumo-/hematothorax. One of the last diagnostic fields in such setting of CXR is the mediastinal vascular injury. These injuries are rare yet life-threatening events. The most easily accessible diagnostic tool to identify these patients would be CXR as it is still one of the standard diagnostic tools in the early assessment of severely injured patients with significant thoracic trauma (Abbreviated Injury Scale, AIS ≥3). This study evaluates the role of early CXR in the Trauma Resuscitation Unit (TRU) in the last diagnostic field where eFAST cannot provide an answer: detecting mediastinal vascular injury in severely injured patients.Method: This retrospective, observational, single-centre study included all primary blunt trauma patients of a 24 months time period, that had been admitted to the TRU. Mediastinal/chest (M/C) ratio measurements were taken from CXRs at three defined levels of the mediastinum. The accuracy of the CXR findings were compared to whole-body computed tomography scans (WBCT) and therapeutic consequences were observed. Additionally a 15 years (2005–2019) time period out of the TraumaRegister DGU® was evaluated regarding usage of eFAST, CXR und WBCT in Level-1, -2, and − 3 Trauma Centres in Germany.Results: A total of 267 patients showed a significant blunt thoracic trauma (27 with mediastinal vascular injury (VThx)). The initial CXR in a supine position was unreliable for detecting mediastinal vascular injury. The sensitivity and specificity at different thresholds of maximum M/C ratio (2.0–3.0) were not clinically acceptable. The aortic contour and haemato- and pneumothorax were not reliably detected in the initial CXRs. No significant differences in the cardiac silhouette were observed between patients with or without mediastinal vascular injury (mean cardiac width, 136.5 mm, p = 0.44). No therapeutic consequences were drawn after CXR in the study period. The data from the TR-DGU (N = 251,095) showed a continuous reduction of CXR from 75% (2005) to 25% (2019), while WBCT raised from 35% to a steady level of about 80%. This development was seen in all trauma hospitals almost simultaneously.Conclusion: In present guidelines, CXR remains an integral diagnostic element during early TRU management, although several prior publications show the superior role of eFAST. Our data support that in most cases, CXR is time consuming and provides no benefit during initial management of severely injured patients and might delay the use of WBCT. The trauma centres in Germany have already significantly reduced the usage of CXR in the TRU. We therefore recommend to revise current guidelines and emphasise eFAST and rapid diagnostic through WBCT if rapidly available.

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