People who suffer serious injury (which is known as major trauma) need the highest quality specialist care to give them the best chances of survival and recovery. From 2010, Londoners will receive new world-class trauma care through the London trauma system. The system is made up of four trauma networks, each with a major trauma centre for treating the most seriously injured patients, linked in with a number of local trauma units for treating those people with less serious injury. The system will save about 100 lives a year and prevent disability for many more.
Ambulance crews will use an agreed protocol to take injured people to the hospital most suited to their needs. The most seriously injured will be taken to a major trauma centre . The majority of people will continue to receive treatment in their local trauma unit. If patients arrive in a trauma unit and then require the specialist services of a major trauma centre they will be stabilised and transferred immediately to the major trauma centre for treatment.
The National Clinical Director for Trauma Professor Keith Willett is highly supportive of the new London trauma system.
“The launch of the London trauma networks represents the culmination of extensive planning and co-operation contributed to by patients, commissioners, managers and many disciplines of clinical staff. These networks will not only be of significant benefit for the severely injured patients of London but will be used extensively across the rest of NHS England as those areas roll out their regional networks for major trauma over the next 2 years. Their strength will lie in the professional consensus that has been achieved and the “can-do” attitude of all those involved. We keenly await the benefits for patients.”
About the system
London’s new trauma system has been designed to ensure that seriously injured patients in the capital receive world-class specialist care. This is achieved through a network of four major trauma centres, located at The Royal London Hospital (Whitechapel), King’s College Hospital (Denmark Hill), St George’s Hospital (Tooting) and St Mary’s Hospital (Paddington). There, specialist teams provide treatment for major trauma injuries 24 hours a day, seven days a week. These centres are supported by a number of trauma units located in A&E departments, where patients with less serious injury will receive their treatment.
Three leading trauma specialists – Professor Keith Willett (National Clinical Director for Trauma), Professor Keith Porter (Professor of Clinical Traumatology at University Hospital Birmingham) and Lieutenant Colonel Adam Brooks (Consultant Surgeon for both the NHS and the army) – carried out an external assessment in January 2010 of the London trauma system’s readiness for operation. This process gave the assurance that the system was ready to deliver along the agreed timeframes. Following this, the Royal London Hospital, King’s College Hospital and St George’s Hospital will go live and accept major trauma patients in April 2010 with St Mary’s going live in October 2010.
A large number of training courses have been run in preparation for the opening of the system. Around 200 staff have received training in Advanced Trauma Life Support© where actors are used to help train medical teams in trauma management. This uses a number of protocols to ensure care is delivered effectively. A number of surgeons have attended the Definitive Trauma Surgical Skills course run by the Royal College of Surgeons which teaches the surgical techniques required for dealing with life-threatening injuries.
Fifty staff attended the Emergency Management of Severe Burns course to learn the skills required when dealing with people who have sustained severe burns. Nurses and therapists have been attending specialist trauma and rehabilitation training to enable them to care effectively for trauma patients. Nearly 100 diagnostic specialist staff have received training in radiology for trauma.
A number of courses are being developed in London to support the teams who will be treating patients. The trauma team leader course will equip the doctors who will initially stabilise seriously injured patients coming into A&E.
All four trauma networks have been funded to purchase advanced trauma simulation equipment to enable teams to practice and learn in simulated trauma scenarios. This allows development of advanced skills in a classroom environment with time for practice and improvement in trauma skills.
Major incident planning
The establishment of trauma networks will help to facilitate delivery of the London major incident plan. The team has been working closely with NHS London’s Department of Emergency Preparedness to plan the best way of achieving this goal. In addition, a table-top exercise was held in March where the networks practised their response to a number of large scale scenarios involving large numbers of injured patients. This exercise also had representation from London Ambulance Service, ambulances services adjacent to London, police and fire brigade, and senior representatives from NHS London acting as the command and control. Services such as paediatric retrieval and burns and the helicopter emergency service were in attendance to provide specialist input. The exercise produced a lot of helpful information which is being incorporated into the emergency planning response in London to utilise the trauma networks effectively in such a scenario. A further follow-up exercise will be held later in the year.
Trauma patients in North West London
A transition plan is in place for the north west London sector. This has been agreed with the trust, commissioners, London Ambulance Service and the London Trauma Office. During this time, ambulance staff will coordinate the transfer of major trauma patients in that area based on the injury they have sustained. This may be the local hospital, Charing Cross Hospital, St Mary’s Hospital or one of the existing three major trauma centres.
There are about 1,600 major trauma cases each year in London (0.1% of all A&E cases). Most of these cases happen in central London.
Major trauma patients have complex injuries – either one very serious injury or a number of injuries which make management of these patients very challenging. They require expert care from a large number of different specialties to give them the best chance of survival and recovery. Until the launch of the London trauma system few of London’s hospitals were set up to provide this highly specialised care for major trauma patients.
The evidence shows that dedicated major trauma centres with expert teams of professionals can save more lives.
Plans to develop a trauma system for London were based on evidence which showed that most trauma patients in London and across the UK receive poor care. The National Confidential Enquiry into Patient Outcome and Death in 2007 found that over 50% of patients receive sub-standard care.
International comparisons showed London lagging behind other major cities in its treatment of trauma patients. Death rates for severely injured patients who are alive when they reach a hospital are 40% higher in the UK than in some parts of the US, where they have developed effective trauma systems.
In 2007, Lord Ara Darzi wrote a landmark review, Healthcare for London: A Framework for Action, which set out an ambitious vision to transform health and healthcare in London. The review recommended there should be greater centralisation of major trauma services based on networks that link local services with specialist centres.
From 31 January to 8 May 2009, Healthcare for London, held a major consultation, The shape of things to come, on plans to improve major trauma and stroke services. Following the consultation, a committee of PCTs decided to introduce four major trauma centres and better local services across London.