Trauma care is inadequate, claims report

A major study on trauma care suggests nearly half of all severely injured patients do not receive good care.

In its report: ‘Trauma: Who Cares?’ The National Confidential Enquiry into Patient Outcome and Death (NCEPOD), an independent charity reviewing clinical practice, claims medical staff often didn’t appreciate the severity of illness, displayed little urgency in caring for patients, and made incorrect clinical decisions.

The report stated that the lack of seniority and inexperience of the staff involved in the immediate management of trauma patients, caused many of the problems, with greatest inadequacies found during the evenings and night – a time at which trauma often occurs.

NCEPOD's recommendations have been backed by the BMA. Dr Jonathan Fielden, chairman of the BMA's Consultant's Committee, said the report demonstrated how consultant expansion was vital to improve patient care. But he warned that staff shortages could hinder improvements.

“The BMA fully backs NCEPOD’s recommendation that a consultant should be the team leader in managing the care of severely injured patients. The problem is that the NHS still does not have enough consultants and patients are suffering as a result. We know that patients’ chances of survival are best achieved by consultant-based care. This is the gold standard of quality care which the government needs to realise is what the NHS and patients need,” said Dr Fielden.

NCEPOD clinical co-ordinator, and one of the study authors, Dr George Findlay said: “We found that the organisation of pre-hospital care, the trauma team response, seniority of staff involvement and immediate in-hospital care was deficient in the majority of cases.”

The NCEPOD report points to no identifiable improvement in the last five years in the care of trauma patients who are transferred between hospitals, noting that transfers are often done in an ad hoc manner by inexperienced trainees with little formal supervision.

Key recommendations from the NCEPOD team include calling on hospital trusts to ensure that a trauma team is available 24-hours-a day and that a consultant is the team leader in managing the care of severely injured patients. It also stated that patients with severe head injury should have a CT scan within one hour of admission, with CT scanner facilities located in emergency departments and that patients with severe head injury should have immediate access to on-site neurological services. In addition, it called for all hospitals to take part in the Trauma Audit & Research Network to enable a UK-wide, strategic overview of trauma care.