Trauma is the epidemic of the 21st century. It is a disease predominantly affecting those in the 3rd and 4th decades of life, striking at them with devastating socio-economic consequences. Currently in the UK, we are the best position we have been in treating this for at least the past 20 years, but there remains much to be done, especially around re-ablement of the survivor.
The conflict in Afghanistan has taught us so much that we can apply for the benefit of our NHS patients. One of the key principles has been the taking of the patient to the most appropriate hospital rather than the nearest. This idea of triage and bypass is not new but empowering the ambulance service to make these decisions has started to avoid the need for secondary transfers between hospitals.
Trauma is classified for statistical purposes using the Injury Severity Score (ISS). This scoring system assigns a numeric value to the patient's injuries. This helps divide the trauma into mild - moderate - severe. ISS of more than 8, represents moderate injury and ISS more than 15 represents severe injury. Severe injury and some cases of moderate injury are best managed in the Major Trauma Centre which has the ability through co-located specialities to deliver the care the patient needs. These patients are identified at the roadside using the pre-hospital triage tool and then they will by-pass the nearest hospital and be taken to the Major Trauma Centre.
In some cases, by-pass may not be appropriate, even in severely injured cases and these will be taken to the nearest trauma unit for stabilisation.
Data is collected in a national database - Trauma Audit Research Network (TARN) - and this is used to reflect performance. The United Kingdom is served by in excess of twenty trauma networks and all are required to submit data to TARN.