Introduction: Trauma systems based on trauma centres have become the gold standard for trauma care in North America. The epidemiology of trauma in the United Kingdom and Australasia is significantly different. The standard of care of patients with blunt injuries in British hospitals may not be as high as in North America. There is ongoing research into the best system of care. Until convincing results are available, adoption of a trauma team approach by all hospitals receiving major trauma would be appropriate. The purpose of this paper is to provide sufficient detail of an operational trauma team to allow others to develop a similar system.
Methods: We introduced a trauma team approach in the Emergency Department of the Royal Brisbane Hospital, a tertiary referral teaching hospital. Laminated action cards detailed precise task allocation to four doctor‐nurse pairs working simultaneously. Equipment, procedures, pathology requests, radiology and clerical duties were standardised in advance. An audit form was completed after each resuscitation.
Results: In an initial review, 108 patients admitted with trauma met criteria for activation of the trauma team. Time of arrival to completion of initial resuscitation was reduced by 63 per cent and time in the department by 51 per cent.
Conclusion: A major component of the success of the best American trauma systems lies in organisation. By contrast, many hospitals in the United Kingdom and Australasia still have no organised response to trauma and where trauma teams do exist, they are often ad hoc and disorganised. The absence of a defined team leader and precise task allocation leads to confusion and delay even when individual team members are highly skilled. We describe a trauma team approach to overcome these problems which could be utilised by any hospital using existing staff and resources.
Teaching trauma management Sir In reference to the article on teaching trauma management in the accident and emergency department (Williams et al., 1991), we are concerned that it may perpetuate the myth that junior staff can and indeed should continue to manage critically injured patients. Many studies have shown that preventable trauma deaths can be reduced from 20-30% to less than 5% with appropriate organizational and staffing changes (Cales et al., 1985; Kreis et al., 1986). The management of major trauma presents a complexity of diagnostic and therapeutic decisions, in addition to requiring skill in multiple invasive procedures that cannot reasonably be expected of junior staff. The ATLS Programme teaches a basic approach to initial trauma care but in no way confers expertise on the participants and is therefore no substitute for management by experienced senior staff. The suggestion that an abbreviated version of ATLS might represent any type of solution to the problem of trauma care by junior doctors is unrealistic. Major trauma is a disease which demands the immediate presence of trained and experienced senior medical staff. Trauma centres, so favoured in the U.S.A., may not be a practical or economic solution in the U.K. environment with its comparatively low rates of trauma. However, redressing the serious imbalance in the ratio of junior to senior medical staff (10:1) in U.K. accident and emergency departments illustrated by Williams would improve the care of all critical and injured patients, not just those with major trauma, and must therefore represent an essential strategy.
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