Trauma anaesthesia and critical care: the post trauma network era

Abstract

Trauma forms a core component of the curriculum for both the Royal College of Anaesthetists (RCA) and Faculty of Intensive Care Medicine (FICM) because of the role that anaesthetists have in the management of every stage of major trauma, from point of injury to rehabilitation. Major trauma is defined as an injury severity score (ISS) .15, although this is not a clear cut-off and the injury pattern itself also has a bearing on the survivability. (Calculation of the ISS is shown in Table 1). The commonest cause of major trauma in the UK is road traffic collisions, resulting in .20 000 cases and 5400 deaths. In 2000, the Royal College of Surgeons recommended that major trauma should be organized into networks, with smaller units acting as feeder hospitals for major trauma centres. It further suggested that each region needed a major trauma plan, defining a definitive pathway for severely injured patients; including ambulance protocols, hospital capabilities, and interhospital transfer guidelines. A 2008 National Health Service review concluded that the arguments for major trauma centres were compelling. This in turn led to the appointment of a national clinical director of trauma in 2009 and the formulation of a Department of Health (DoH) regional trauma networks programme. They recommended that to maintain major trauma credentials, a hospital needs to see .650 major trauma cases per year. The London Trauma System commenced on April 1, 2011 and many other regions in the UK have or are currently developing their own systems. It is recognized that currently some regions do not have all acute surgical specialities represented requiring cross network cooperation to ensure equal access to treatment for time-critical interventions. In the 2000–2009 time period, the numbers of critical care beds in England increased by .1300 but capacity issues remain and ICNARC data indicate that only two-thirds of critical care moves in trauma patients are for clinical reasons. Pre-hospital care