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Trauma and Pre-Hospital Care with Mike Penning MP

Mar 23. till Nov 24.

2020health Expert Roundtable on Trauma and Pre-Hospital Care with Mike Penning MP

Roundtable on Trauma and Pre-Hospital Care.

Date
March 23, 20102010-03-23T12:30:00 - November 24, 2010 2010-11-24T02:00:00
Time
12:30 PM 2010-03-23T12:30:00 - 2:00 PM 2010-11-24T02:00:00
Location
Westminster, London

Attendees

Mike Penning MP, Shadow Minister for Health
Julia Manning, Chief Executive, 2020health
Earl Howe, Shadow Minister for Health
Dr Richard Steyn, British Association for Immediate Care
Dr John Black, South Central Ambulance Service
Dr Howard K. Simpson, Basingstoke & North Hampshire NHS Foundation Trust
Barry Johns, Response Group
George Cranmer, Cranmer Lawrence & Company Ltd
Ken Hunnisett, Cranmer Lawrence & Company Ltd
Dr Phil Hyde, Birmingham Children’s Hospital
Dr Fionna Moore, London Ambulance Service
Professor Keith Porter, Faculty of Pre-Hospital Care of the Royal College of Surgeons of Edinburgh
David Davis, South East Coast Ambulance service NHS Trust
Professor Andy Newton, South East Coast Ambulance service NHS Trust

Event Summary

Accidents of trauma are highest between 4pm-2am and the weekends, however it is important to remember that trauma goes beyond road traffic accidents.

In comparison to USA, we have poorer survival rates: the UK needs greater multidisciplinary action. Care is not all about clinical skills; both clinical and medical staff should be trained by the Deanery and not just medical staff which is the current case.

Trauma patients are of a small population and within this major trauma patients even more so. These specifically require a high level of skills provided to them, it does not matter who so long as they possess the right skills to do so.

2 key points:

• Does the skill base match the number of patients coming through the doors for trauma?
• The geographical distance present to physically move the patient from A to B

Transport platforms are key to get the patient to the right place and this would be the best situation but we have a problem with the number of platforms available. Therefore the solution is options – having an option of platform vehicles to choose from.

There are 31 aircraft for medical emergencies in the UK and most are charity funded – only 4 deliver the skill-set required for trauma care?

Many hospitals that have trauma departments have no helipads and so patients close to a hospital are not taken there because it is lacking a helipad and instead are transported to a hospital further away. This wastes invaluable time and limits our options.

If you have the right skill set existing within your team, you can take the emergency department to the patient instead without having to transport immediately. Each geographical region is widely diverse and needs different teams, but they all still need the right clinicians and the NHS does not provide this apart from in London.

Trauma needs to be viewed in terms of a wider emergency care landscape: how can we improve non major incidents? It is very difficult to tie down ambulance crews and give them times to train with hospitals and clinicians – a joint service is needed.
Has been reported that we can save £7 billion/year with better standards and procedures. There is a need to free up utilisation rates in hospitals.

Best practise means best skill set. Physician and clinical care practitioner teams are required.

1 SHA has funded a medical model, and if the NHS funded ambulance teams it would be a step in the right direction.

Split into:
90% medical emergencies: 30% = Life threatening e.g. strokes, heart attacks and 70% = long term conditions that get out of hand
10% Trauma: 1% = major trauma

Mention of homecare providers – wanted concierge services.

Ambulance trusts need the most efficient and cost effective core skills and an external organisation could provide these.

The UK could potentially have a world class system for patient needs, and develop this by bringing back lessons learned from experiences in other countries e.g. medical teams in Afghanistan who provide fast and efficient trauma care in highly dangerous environments (especially compared to the UK).

There is not yet a merit function in London but a small amount of money has been given to pilot one. We must replace the requirement for trauma to produce mobile units – is an advantage to have Drs with the experience and skills especially in trauma on these units.
Case: Amputation rate = 50% if patient is taken elsewhere first and then to the second hospital. The second hospital has better skill set when it comes to trauma care.
Well defined and well validated skills that fit the purpose are needed.

The problem with trauma is that we deal with relatively small numbers but the stakes are very high (death). In other departments such as obs and gyn having enough midwives in large centres is a problem but it is possible to predict/estimate the number of babies to be born but hard to predict trauma cases as they are so random.

Trauma networks – huge reorganisation is going on. Up until now it has been known that in order to do the job well, teams need more staff and more resources. Though we now acknowledge we need to move the existing workforce as we will not get this extra staff in the current economic climate.

From a workplace point of view the bigger picture must be seen – as trauma also concerns other emergencies e.g. strokes
With our shrinking budgets it is even more so important to pin point what service teams need and who can deliver that.

At present there are 27 models for ambulance services.

Training staff to a high level is needed where they receive dedicated feedback and coaching as well as recommisioning. Leadership audits are important but less so than actual physical work.

As trauma involves such a small number of people for example against cancer care – it is hard to identify the 1% for pre hospital care.

Discouragement of bypassing local hospital. An integrated pre hospital service is needed so that pain and suffering can be changed drastically.

There is a problem that the money saved is downstream and the benefits seen in rehab i.e getting people back to work. Getting people to realise this and invest in trauma care needs tackling.

Vehicle off road wastes precious time – if an ambulance has a headlight missing it cannot go to the patient and drivers are liable for accidents.

Justifying upstream investment is needed but is difficult because organisations want the evidence and figures for this to show a model or procedure is the best way and uses the best competencies. There is an electronic system that gives information about time taken to get to the patient and transport using the point of incidence and point of discharge. Such methods must be proven in order to be considered for implementation.

Teams should be getting the right skill set to the right patient at the right time using an integrated team. Sometimes the patient is worse off after they are transported and left at hospital than when they were initially brought in and this is unacceptable.

Evidence based practice is not enough – professionals need the desire to make it work – saying the model/method will correct things going wrong is not enough.

Idea that we should extract the best bits of international models:
• German model – Dr led – found to be best for trauma
• UK – Paramedics led
• Spanish – Life.... led – best value for money in everything apart from trauma

Emergency case mix could be embraced into trauma care. Targets are a good measure for improvement but they distort the clinical pathway. Often the targets drive care, which is often poor care.

Clinical champions should be at the forefront of trauma care – there is a difficulty in making the public understand reasoning behind methods/models particularly when it comes from politicians – a clinical push is therefore required as a better method
At the present it is not clear which are the most important drivers to change:

• Ambulances?
• Care pathways?
• Skill set?

This is a key question in forming a new blueprint for trauma care.

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