Scotland lags behind the rest of the world in its provision of care for major trauma victims, concludes a report from the Royal College of Surgeons of Edinburgh. And a network of a specialist centres for major trauma needs to be developed, it says.
The fact that deaths among severely injured inpatients is 40% higher in the UK than in North America has prompted a shift in healthcare policy in England, but nothing has changed in Scotland, says the report.
Trauma is the leading cause of death among the under 45s, and in Scotland, is responsible for around 1300 deaths a year. It is also the commonest cause of death in children and accounts for more deaths in children and adolescents than all other causes combined.
A trauma network across Scotland, which focuses on reducing disability as well as mortality, should be developed, says the report.
It recommends that major trauma patients be treated at a small number of dedicated major trauma centres, serving a wide geographic area. These centres would have access to all the necessary specialties on one site, and would be fully resourced with appropriate equipment and medical staff.
Less severe cases could be dealt with in less specialised trauma centres, which would have a more regional focus and an intake from the local catchment area.
This approach is equivalent to that already in use in North America and currently being adopted in England.
“Major trauma treatment requires a precise set of skills and knowledge; it also needs to pull together expertise from a wide range of specialties and resources,” comments one of the report’s authors, consultant orthopaedic surgeon and College Vice President Mr Ian Ritchie.
“Under the current system in Scotland, major trauma patients are sent for treatment at the nearest local hospitals which may not have access to all the resources and specialisms needed,” he adds.
It had been thought that the system recommended in the report would not work in Scotland. This was mainly because the country’s terrain, coupled with the way communities are dispersed, could mean longer journey times for patients needing to reach specialist care.
But it is now believed that, as long as the patient is stabilised, the length of the journey to final treatment is not as crucial as was once thought.
“It is more important that the patient is delivered as soon as possible to a hospital and a team which is fully equipped to deal with the unique requirements of major trauma patients,” says Mr Ritchie.
“If necessary, under the new system, major trauma patients could be taken to a local trauma unit to be stabilised, but it would be crucial they were then transferred to a major trauma centre as soon as possible,” he explains.
“Experience suggests that major trauma patients and their families would accept a longer journey in the knowledge that they are in the best place and receiving the best care available.”
The report emphasises that more research and consultation are needed to determine the exact configuration of any new system.
In general, trauma care in Scotland is of a very high standard; however we can do better for those people who are very seriously injured. This report represents the beginning of a process which we hope will ultimately provide even better services for our patients in Scotland,” says Mr Ritchie.