Major trauma describes serious and often multiple injuries where there is a strong possibility of death or disability. These might include serious head, chest, abdominal and skeletal injuries sustained as a result of accidents, sport or violence. Major trauma is the main cause of death for people under the age of 45 and is a major cause of debilitating long term injuries. More than half of major trauma is caused by road traffic collisions.
There are approximately 1,500 people (children and adults) in Northern Ireland each year who sustain significant trauma. Two thirds of this group sustained moderate trauma with potentially life-changing injuries; one third are the most seriously injured with life-threatening or life-changing injuries.
Whilst this is a relatively small number from a population of 1.8 million, major trauma patients have complex injuries and need expert care to have the best chance of surviving and recovering.
Until 26th October, trauma patients may have been taken to local acute hospitals, even if they were within 45 mins of a specialist centre. Often these patients would then be transferred to a specialist centre which may have resulted in a delay in their treatment.
Whilst all hospitals with Type 1 Emergency Departments across Northern Ireland treat both adults and children involved in major trauma, patient outcomes are improved with the introduction of regional trauma networks which include trauma bypass to a Major Trauma Centre (National Audit Office Report, 2010) On 26 October, major trauma bypass will be introduced in Northern Ireland to give trauma patients the best chance of survival and recovery wherever they live.
At the scene of an incident, ambulance responders, trained in major trauma triage, will assess the patient and identify the most appropriate hospital.
If it is safe and appropriate to do so, the patient will be taken to the Major Trauma Centre at the Royal Victoria Hospital in Belfast; otherwise the patient will be taken to the closest Type 1 Emergency Department (ED). This may be because the patient needs stabilised before being transferred to the MTC or his/her injuries are less severe and can be treated in the local hospital.
Patients with less severe injuries, urgent or emergency care needs will continue to be treated by their local ED, Minor Injuries Unit or GP.
The Major Trauma Centre (MTC) is part of the major trauma network. The Royal Victoria Hospital (RVH) has been designated as the adult MTC in Northern Ireland.
It is a specialist centre providing the most severely injured patients with direct access to the specialist trauma team, state-of-the-art equipment and a wide range of specialist clinical services. It will operate 24 hours a day, seven days a week.
The specialist trauma team includes a senior Emergency Medicine doctor (Team Leader), senior Registrars in orthopaedics, anaesthetics and general surgery; along with anaesthetic support staff, radiologists, emergency medical nursing staff and porters.
Type 1 EDs are situated in acute hospitals throughout NI. They are part of the major trauma network providing care for adults and children with serious injuries as required. When it is not possible to get to the major trauma centre within 45 minutes, or where the patient needs to be stabilised quickly, the patient is taken to the nearest Type 1 ED for immediate treatment and stabilisation before being transferred on to the Major Trauma Centre.
When a patient is discharged from the Major Trauma Centre, local acute hospitals also provide on-going treatment and rehabilitation for patients.
Type 1 Emergency Departments are:
Belfast Health and Social Care Trust
Northern Health and Social Care Trust
South Eastern Health and Social Care Trust
Southern Health and Social Care Trust
Western Health and Social Care Trust
Trauma patients will stay in the Major Trauma Centre only as long as specialist services are required. If further acute hospital care is needed, the patient will be repatriated to their local hospital for treatment and onward referral to local community and support services.
The benefits associated with implementation of a major trauma network are:
Patient outcomes will be improved:
Mortality rates associated with major trauma will be reduced:
The major trauma network will facilitate the establishment of more effective clinical teams:
The major trauma network is a long-term sustainable service:
In some cases, patients may have to travel longer in the ambulance to the MTC than they would have done if they were being taken to their local ED. However, the journey is unlikely to take longer than 45 minutes and it means patients are treated in a specialist centre with all the facilities and expertise they may need. They will not need to be transferred from a local hospital, which would incur delays to treatment and could have adverse effects on survival.
When it is not possible to get to the Major Trauma Centre within 45 minutes, patients will be taken to the nearest Type 1 Emergency Department for immediate treatment and stabilisation before being transferred on to the MTC.
For major trauma patients, spending a little extra time getting to a hospital which provides the right team of specialists is more important than getting to the nearest hospital. Specialist treatment at the MTC has a greater impact than journey time (i.e. the time spent in an ambulance) on medical outcomes and can increase survival rates by up to 20%.
Major trauma in children is thankfully very rare. We are fortunate in Northern Ireland that every Type 1 ED can provide high quality trauma care for critically ill children. However, similarly to adults, the most seriously injured will be taken directly to a specialist centre that will provide a full range of consultant-led specialist services. This centre is the Royal Belfast Hospital for Sick Children (RBHSC).
No, the introduction of a major trauma network is not about reducing ED services nor will EDs be affected. The change is focused on enhancing strategically-placed services to ensure that the relatively few people who suffer major trauma get the best care as quickly as possible.
EDs will continue to receive patients with injuries that need urgent treatment, but do not require specialist services, as is the case with major trauma patients. However all Type 1 EDs can continue to treat major trauma patients, as required.
Local ED staff will continue to operate as normal, in line with the normal requirements of a Type 1 department
The air ambulance will operate as normal. The aircraft used by HEMS has the ability to reach the MTC from anywhere in the country within 45 minutes.
The provision of major trauma care is a protected service; however, UK pandemic guidance for major trauma networks may mean that adjustments are made to the system in response to unavoidable pressures.