Improving UK trauma care: the NCEPOD trauma report

Abstract

As representatives of the Royal College of Anaesthetists on the Joint Royal Colleges Ambulance Liaison Committee (JRCALC), we read with interest David Lockey’s sensible Editorial ‘Improving UK trauma care: the NCEPOD trauma report’ [1] and would like to take the opportunity to respond to some of the shortcomings highlighted. Since 1989, the Joint Royal Colleges Ambulance Service Liaison Committee, has provided a national forum to support the UK Ambulance Service with a particular focus on its interactions with other professional healthcare groups. The committee has widespread representation including the Ambulance Service, the Royal Medical Colleges including that of Physicians, Surgeons, Anaesthetists, Obstetricians & Gynaecologists, General Practitioners, Nursing, Paediatric and Child Health, Emergency Medicine and observers from the Department of Health, The Scottish Ambulance Service, the Health Professions Council and the Institute of Healthcare Development. The Editorial underlined a number of valid points concerning the prehospital phase of trauma care such as excessive on-scene time (though rightly acknowledged as often being circumstance driven), the recording of an inappropriate prehospital secondary survey, the failure to give oxygen (though in our experience this is much more likely to be a failure to record the fact on the ambulance crew Patient Record Form) and omitting to provide a pre-alert to the hospital. These are fortunately, all factors that can be speedily resolved by educational reinforcement and without the need for significant extra resources. However, whilst there may be reservations over the robustness of the data used to support some of the prehospital findings of the report, the clear recognition of the suboptimal level of airway management should concern us all whether as anaesthetists or prehospital care providers. To address this shortcoming is indeed a challenge and an expert group recently formed at the request of JRCALC has already looked in detail at possible contributory factors. The summary of its findings, though not yet formally published, is already provoking widespread and far-ranging discussion. In his penultimate paragraph Dr Lockey suggests that an examination of the entire patient journey from roadside to rehabilitation may meet some resistance ‘particularly from ambulance services’, but we would strongly disagree that the latter are reluctant to pursue any achievable means to ensure optimum patient care. The way forward is to make certain that ambulance services are an integral part of the discussions to determine how we all address the persistent inadequacies of UK trauma care as presented in this salutary report.