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Trauma care under fire

21/11/2007

Calls have been made for urgent improvements to trauma care after a report found that nearly half of severely injured people received inadequate care.

Each year in the UK there are between 3,000 and 4,000 cases of severe trauma.

The National Confidential Enquiry into Patient Outcome and Death (NCEPOD) revealed problems in both clinical and organisational aspects of care and said significant improvements are needed urgently in pre-hospital and hospital treatment.

Organisation of immediate in-hospital care, seniority of staff involvement, the trauma team response and organisation of pre-hospital care was found to be deficient in the majority of cases.

No identifiable improvement in the care of trauma patients who are transferred between hospitals - about 800 every year - was found in the last five years, with the transfers often undertaken in an ad hoc manner by inexperienced trainees.

NCEPOD also found that more than half of trauma patients who needed neurological services were taken to a hospital where there was no on-site service.

One-fifth of hospitals did not have a dedicated trauma team and a third of patients were not seen by a consultant in the emergency department.

Commenting on the findings, NCEPOD co-ordinator and report author Simon Carter said: "We need to see significant improvements made now to pre-hospital and hospital trauma care in order to prevent the unnecessary death of young patients with its tragic consequences for families, not to mention the economic cost to the nation."

Improvements advised by the NCEPOD include the need for hospital trusts to ensure a trauma team is available 24 hours a day and for a consultant to be team leader in managing the care of a severely injured patient.

Regional planning of trauma services, including pre-hospital physician involvement and reconfiguration of services, is also advised. NCEPOD recommends that this planning could include a doctor being a member of ambulance crew in trauma cases.

CT scanning equipment must be located within emergency departments, the report says, as it will play an increasing role in the investigation and management of trauma patients.

In response to the report, the British Medical Association (BMA) said it "fully backs" the recommendation that a consultant should be the team leader in managing trauma cases.

"The problem is that the NHS still does not have enough consultants and patients are suffering as a result," said Dr Jonathan Fielden, chairman of the BMA consultants' committee.

"We know that patients' chances of survival are best achieved by consultant-based care. This is the gold standard of quality care which the government needs to realise is what the NHS and patients need."

Dr Gill Morgan, chief executive of the NHS Confederation which represents 90 per cent of NHS organisations, added that the report emphasises the need for patients to be taken to centres specially equipped and staffed to deal with their condition.

"This is not about the centralisation of accident and emergency services across the board, but about ensuring that the small number of patients with severe trauma receive the best and safest care which offers them the greatest chance of survival and the greatest chance of full recovery," she explained.