Abstract
Trauma is one of the leading causes of death and disability worldwide and is a major global public health problem. The provision of trauma care has been substandard in England and Wales prior to the implementation of an inclusive major trauma network system in London in 2010 and subsequently across the rest of England two years later. The implementation of the London trauma system has brought about improvements to the delivery of trauma care by decreasing the overall morbidity and mortality significantly. This framework encompasses the collaboration of emergency services, designated Major Trauma Centres (MTCs), Trauma Units (TUs) and community providers which have been optimized with the expertise and resources to provide the best outcomes for major trauma patients. Specific triage protocols, consultant-led trauma service and on-the-spot access to radiology services and operating theatres have played a pivotal role in the improvement of trauma care. In spite of several strengths, however, the London major trauma network system is by no means without its limitations. The emergence of the new coronavirus disease 2019 (COVID-19) pandemic has created major barriers to the smooth running of trauma services by exhausting resources due to infection control measures, reduced theatre space and re-deployment of medical staffs. In addition, the cancellation of elective surgeries has impacted directly on the training of surgical trainees by leaving them with significantly reduced surgical exposure. As a results of this ever changing surgical landscape, a need to urgently review these traditional surgical training methods with a view to modernize the curriculum. Although the London trauma system has evolved significantly since its implementation, its limitations should be recognized and addressed to enhance performance and improve patient outcomes.
Highlights
BackgroundTrauma is one of the leading causes of death and disability worldwide and is a major global public health problem
A report of the National Confidential Enquiry into Patient Outcome and Death (NCEPOD) in 2007 showed that almost 60% of major trauma patients across England, Wales, Northern Ireland and Offshore islands had received a standard of care that was less than good practice
The London trauma framework encompasses four trauma networks (North West London, North East London and Essex, South West London and Surrey, South East London, and Kent trauma networks). Each of these networks is led by a Major Trauma Centre (MTC) to treat the most critically wounded patients, and each Major Trauma Centres (MTCs) is associated with other local Trauma Units (TU) for patients with less serious injuries
Summary
Trauma is one of the leading causes of death and disability worldwide and is a major global public health problem. MTCs have been optimized with the expertise and resources to provide the best outcomes for major trauma patients They have dedicated trauma teams and provides emergency access to consultant-led trauma service with multi-specialty care (such as general, emergency medicine, vascular, trauma and orthopaedics, plastic, spinal, maxillofacial, cardiothoracic and neurological surgery, critical care, and interventional radiology) around the clock. The designation of a dedicated consultant-led trauma team approach allows for quicker evaluation and resuscitation, which can lead to a decrease in time from injury to vital interventions [8] They state that the availability of an attending trauma surgeon on the trauma team 24 h a day reduces resuscitation time and time to the incision for emergency operations. This, in conjunction with effective triage, consultant-led service provision, and concentration of resources to where it is required most, has improved the care of the trauma patient across the network
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