Major trauma care in England

Abstract

Trauma is the leading cause of death worldwide in children and adults under the age of 40 years. In most western countries this is due to blunt trauma and road traffic accidents, although in the developing world penetrating trauma has a much larger role. The earliest recorded road traffic fatality was in England in 1896 when a young mother, visiting London with her daughter, was struck by a car travelling at a “tremendous speed”. The car was perhaps the first aftermarket ‘tuned car’; its gear ratios had been altered by a Mercedes Benz engineer to double the flywheel speed. This collision, at four miles an hour, caused massive head injuries and the mother died at the roadside. The coroner at the enquiry was reported to have remarked “I trust that this sort of nonsense will never happen again”. Unfortunately, just two years later, the first driver fatality occurred and today there are at least 20,000 cases of major trauma a year in the UK alone. These result in 5,400 deaths and, for those who survive, the injuries may change their lives with permanent disability affecting both the patient and their family. The early systems for the management of trauma in the UK were driven by two reports. The first in 1935, titled British Medical Association’s Committee on Fractures1, and a subsequent study by the Interdepartmental Committee (1939).2 These highlighted inadequate care of the injured patient throughout the British Isles. While these reports were for the most part ignored, they did result in the formation of the Birmingham Accident Hospital and Rehabilitation Centre, probably the world’s first modern trauma centre, and widely regarded at the time as a radical plan to treat injured patients in a specialised setting. The Birmingham Accident Hospital was staffed by specially trained trauma …