Major Trauma

What is Major Trauma?
Major trauma can be defined as a serious and life-threatening physical injury, often following an accident of some kind, with the potential for secondary complications such as shock, respiratory failure and death.

Trauma at University Hospital
The University Hospital of North Staffordshire has a national reputation for treating patients with multiple injuries. In 1991, it served as the UK's pilot Major Trauma Centre and has maintained a high-level, multi-disciplinary service ever since.

Each year, about 1,000 patients are admitted with serious injuries, including up to 200 that are classified as having suffered severe trauma. Most patients have been involved in motor vehicle collisions or falls, but the Trauma Service must be prepared to deal with a wide range of mechanisms of injury, including stabbing, shooting and explosions. The hospital serves a local population of 500,000 in North Staffordshire and acts as a tertiary centre for the wider population of 1.7million in the North West Midlands. Whilst most patients are brought in by land ambulance, the West Midlands helicopter Air Ambulance is of pivotal importance in bringing critically injured patients directly from the scene to the awaiting Trauma Team.

Patients with potentially life-threatening injuries are managed from the outset by a Consultant-led Trauma Team 24 hours a day, 7 days a week. The Team resuscitates the patient in the Emergency Department and coordinates investigations to identify all the injuries.

Specialist Surgeons are called in to provide definitive treatment of complex injuries and Intensivists provide ongoing critical care to keep the patient alive. The majority of the serious (but not life-threatening) injuries are fractures to the upper and lower limbs, pelvis and spine. Patients with these injuries need the expertise of the Trauma Orthopaedic and Spinal Injury teams to restore function and minimise disability, sometimes with multiple reconstructive operations.

Key Relationships
More than half of the patients with severe (potentially life-threatening) trauma have major head injuries and need the expertise of our Neurosurgical team.. However, major trauma can affect any part of the body, so other specialties such as General Surgery, Vascular Surgery, Cardiothoracic Surgery, Maxillofacial Surgery and Plastic Surgery are also regularly involved. The hospital is one of only 17 hospitals in the UK that has all the surgical specialties to provide a comprehensive service.

Radiologists play a vital role not only in injury diagnosis, but also in stopping some types of life-threatening bleeding using interventional techniques that complement the surgical approach to haemorrhage. The Trauma Service relies on laboratory services to provide blood and blood products to replace blood lost and to maintain the blood’s ability to clot.

While emergency action is needed to save lives, expert rehabilitation is essential to achieve the best recovery and within the hospital this is a process that is initiated within a few days of admission with Consultants in Rehabilitation Medicine, together with the Head Injury Coordinator providing active support.

Unlike other Directorates, the Major Trauma Service is inherently multi-disciplinary and works throughout the hospital rather than in one department. The initial focus is in the Emergency Department and it is here that initial contact is made with the Trauma Team. After completing the initial assessment and providing immediate care, the Consultant Team Leader explains the situation to patients and their relatives and answers any questions they have.

Process of Care
Patients who need life-saving surgical interventions are taken promptly to the Operating Theatre. In extreme situations, patients may be taken there directly from the helipad. Critically injured patients who do not require or who have completed surgical procedures are taken to the Multiple Injuries Unit (MIU) for intensive care.

Emergency Physicians and Anaesthetists form the core of the Trauma Team and play a crucial role in maintaining organ system support in the Emergency Department. The Anaesthetists maintain continuity of critical care through the Operating Theatre into the MIU.

Patients who are less seriously injured or who have improved following a period of intensive care are transferred to the Acute Surgical Wards. Patients referred from other hospitals in the Trauma Network are transferred back to their home area as soon as it is safe to do so.

Rehabilitation is of key importance in major trauma care and is initiated within the first few days of admission. Patients who need intensive rehabilitation are transferred to the Haywood Rehabilitation Unit to help optimise their recovery.