‘Trauma: we care’

Abstract

During the 2008 Annual scientific meeting of the Neuroanaesthesia Society of Great Britain and Ireland a session was dedicated to transfer of head injured patients. It became immediately apparent that problems exist regarding awareness of national guidelines for transfer of the critically ill. Transfer training of anaesthetists and organisation of transfers is a national problem and guidelines for transfer are not followed [1-4]. Despite guidelines there are still a few issues that doctors are not clear about [5]. An example of poorly understood guidelines is the fact that only a tiny number of doctors are aware of the fact that you are not covered by any insurance for standing or moving around in the back of an ambulance during transfer. We know that the armed forces maintain a high standard for transfer. Their transfer team includes an anaesthetist and trained nurse who work on the ‘scoop and run’ policy. This is their preferred method of retrieval, with resuscitation being performed in transit. It might be argued that armed forces have no choice except to ‘scoop and run’, but given present resources, this policy is the best option for a civilian setting in the UK. The new NCEPOD report ‘Trauma: Who cares?’ recommendation states ‘if prehospital intubation is to be part of prehospital trauma management then it needs to be in the context of a physician based prehospital care system’ [6]. Heroic attempts at intubation on the scene by non experts in suboptimal conditions could be disastrous for polytrauma victims with possible head, neck and facial injuries. At the moment we rely only on the skills of paramedics whose experience of intubating patients depends upon the quality of anaesthetic teaching that they may get in the anaesthetic room. Simulation centres can provide training to doctors as well as paramedics and nurses to undertake safe retrieval and transfer. Although it is difficult to prove the efficacy of simulation centres for trauma retrieval and transfer training at the moment in the UK, it looks very promising in the context of ‘Trauma: Who cares?’ Although many studies favour intubation and resuscitation at the scene, it only marginally increases the chances of survival [7] but at the cost of running a service which is physician rather than paramedic based [8, 9]. An interesting suggestion, is to have physicians on transfer teams to retrieve severely injured patients as in the armed forces model. Does it mean that we should have transfer doctors with a variety of skills or probably ‘Transfer Clinicians’ who need to be on call for polytrauma? Is it a practical thought? We probably need to invest today for the future. Maybe, just maybe, the Physician’s Assistants in Anaesthesia could have a role here [10]. In summary transfer training needs to be assessed and monitored more closely. We wait with fingers crossed for the Royal College of Anaesthetists to lead the way in this. Perhaps we need a link or affiliation with the Prehospital Care faculty incorporated into training programmes?