15. Acute Care and Surgery Trauma Team and activation Trauma Team Leader Emergency Radiology Emergency Surgery Clinical Advisory Group Recommendations to the Department of Health
16. Care should be led by consultants experienced in major trauma Major trauma is most likely to occur at night-time or at weekends National Audit Office 2010
17.
18.
19.
20.
21.
22. Ongoing Care and Reconstruction Patient-centred care Dedicated trauma wards and theatres Intensive care Repatriation Clinical Advisory Group Recommendations to the Department of Health
24. Mendelow AD, et al . Extradural haematoma: effect of delayed treatment. British Medical Journal 1979; 1 :1240-1241 Acute extradural haematomas have a better outcome if evacuated promptly A delay of more than 2 hours from clinical deterioration to haematoma evacuation led to significantly worse outcome
25. Leach P, et al. Transfer times for patients with extradural and subdural haematomas to neurosurgery in Greater Manchester British Journal of Neurosurgery 2007; 21 :11-15 * Mendelow 1979 ** Seelig 1981 59.0% (59*) GOS 5 (good recovery) 7.2% 7.7% GOS 2 & 3 (PVS or severe disability) 54.8% (34**) 23.1% GOS 4 (moderate disability) 38.1% (57**) 10.3% (17*) GOS 1 (death) 6.0 h 5.25 h Overall transfer time 0.75 h 0.75 h Arrival to surgery 2.38 h 2.5 h CT to arrival 2.25 h 2.0 h Deterioration or injury to CT 42 39 Number of patients Acute Subdural Haematoma Acute Extradural Haematoma
26. Sergides IG, et al. Is the recommended target of 4 hours from head injury to emergency craniotomy achievable? British Journal of Neurosurgery 2006; 20 :301-305 Number of patients 23 Isolated extradural 9 Mixed extradural and subdural 1 Isolated subdural 7 Intracerebral 4 Mixed subdural and intracerebral 2 Number operated < 4 hours of injury 0 GOS 1 (death) 21.7% GOS 2 & 3 (PVS or severe disability) 13.0% GOS 4 (moderate disability) 21.7% GOS 5 (good recovery) 43.5%
32. Rehabilitation Early start Director of Rehabilitation Coordination Country-wide review Clinical Advisory Group Recommendations to the Department of Health
37. The costs of major trauma are not fully understood, and there is no national tariff to underpin the commissioning of services Funding arrangements do not reflect the true costs National Audit Office 2010
38. HRG Grid for Major Trauma Professor Keith Willett (in development)
39. Network Organisation Definitions and designation Boundaries based on needs Responsibility for transfer TARN mandatory Performance framework Clinical Advisory Group Recommendations to the Department of Health
40. By September 2011: TARN Compliance Primary care trusts should use their commissioning powers to require all acute and foundations trusts with emergency departments that receive trauma patients to submit data to TARN National Audit Office 2010
41.
42.
43.
44.
45. Avery B. Nathens; Gregory J. Jurkovich; Ronald V. Maier; et al. Relationship Between Trauma Center Volume and Outcomes JAMA. 2001;285(9):1164-1171