|Trauma care: Getting the right fit for Scotland|
The College has published a report calling for improvements to the configuration of major trauma services north of the border
The surgical management of trauma is one of the earliest skills that a surgeon learns. Worldwide, the mortality from trauma, either civilian or military, is a major cause of death and disability. Scotland, with a population of approximately 5,000,000 people spread over a wide territorial area, faces challenges in the delivery of trauma care for all of its population.
As part of the United Kingdom, surgeons in Scotland have observed the changes that are being made to the delivery of trauma care in England and Wales and are naturally keen to ensure that high standards are achieved in Scotland too. A review of the worldwide literature reveals the benefits that have been achieved in North America in the management of patients with multiple trauma, both in survivability and in their rehabilitation when such care is properly organised.
“The argument that it is important to get a patient to the nearest hospital as quickly as possible has been succeeded by the argument that the important thing is to get the patient to the point of definitive care”
Learning the lessons of research, observing changes in practice and passing that on to its Fellowship are important functions of a surgical College. It is in this context that the College formed the Trauma Working Group to examine the delivery of Trauma care in Scotland, and the report of which will be issued shortly.
The main message of the report is that in the small proportion of trauma patients who suffer multiple injuries, there is a benefit in terms of survivability and improved rehabilitation from treating these patients in specialised units. Experience suggests that a population of 5 million would generate about 900 cases a year which would be an appropriate volume for one unit and which would allow the development of expertise and practiced teams. The argument that it is important to get a patient to the nearest hospital as quickly as possible has now been succeeded by the argument that the important thing is to get the patient to the point of definitive care as quickly as possible. This may involve stopping at a local hospital for resuscitation but mortality and morbidity are reduced by getting multiple-injured patients to definitive care in the shortest possible time.
For the College, the benefits that this kind of reorganisation would bring in terms of training and experience is clear. For a trainee attached to a hospital which receives up to 1,000 multiple-injured trauma patients a year, the exposure will be much greater and their experience will be much enhanced compared to one or two patients per annum in district general hospitals or indeed in city centre teaching hospitals. Furthermore, patients coming to one centre which has all the necessary specialties on-site will generate an expertise which can only enhance the treatment of these patients.
The Trauma Working Group recognises that there are many challenges facing the National Health Service in the United Kingdom today. Wholesale reorganisation is, I'm sure, not undertaken lightly but the literature suggests that concentrating the expertise for multiple-injured patients in fewer sites is a reorganisation that is long overdue. Furthermore, it is not a reorganisation which will result in closure of hospitals or A&E units. Indeed, it may liberate some units to provide even better care for the numerically greater number of patients who have suffered fractured hips, broken ankles and other isolated long bone injuries.
Ian Ritchie, RCSEd Vice President and Member of the Trauma Working Group
Download: RCSEd Trauma Report