Table 2.
Essential characteristics of hospitals delivering trauma care in the Regional Trauma Network (RTN) era
| Characteristic | Types of Institutions offering care to injured patients | |
|---|---|---|
| Major trauma centre (MTC) | Trauma unit (TU) | |
| Total no. for England | 12-16 | 80-100 |
| Administration/governance: | ||
| Commitment from executive team administration and senior clinical staff to deliver such services | 100% | 100% |
| Clinical director for trauma, programme manager and data manager | 100% | 100% |
| Full dataset submission to TARN | 100% | 100% |
| Commitment to RTN, trauma governance, continuous improvement | 100% | 100% |
| Critically injured patients (complex or major trauma) | >250 per year | Only for few cases when the bypass protocols are not followed (patient in extremis, accident in the premises of TU) |
| Accident and emergency (A&E): early resuscitation: | ||
| A&E availability | 24/7 | 24/7 |
| Resuscitation trauma team leader | Consultant 24/7 resident | Experienced middle grade 24/7 resident; consultant on calla |
| Fully staffed with specialist nursing and allied health professionals | 24/7 | 24/7 |
| Band 7 nurse: specialist ED trauma nursing | 24/7 | Variable |
| Activation protocols: established prealert pathways | 24/7 | 24/7 |
| Trauma service: | ||
| Ongoing patient care post initial resuscitation | Consultant on calla | Consultant on calla |
| Admission under a named consultant | Consultant on calla | Consultant on calla |
| Consultant-led service for ongoing coordination of the care of major trauma patients | Consultant on calla | Consultant on calla |
| Trauma nurse coordinator | Yes | Variable |
| Radiology: (X-ray/FAST-CT) | Reporting within 24 h | Reporting within 24 h |
| Available high specification CT scanner | 24/7 | 24/7a |
| Staffed laboratory services | 24/7 | 24/7 |
| Blood bank | 24/7 | 24/7 |
| Massive transfusion protocol | 24/7 | 24/7 |
| Trauma and orthopaedic | Middle grade resident, consultant on calla, pelvic reconstruction service, complex limb reconstruction service | Middle grade resident, consultant on calla |
| General surgery | Middle grade resident, consultant on calla | Middle grade resident, consultant on calla |
| Neurosurgery | Middle grade resident, consultant on calla | Variable |
| Spinal surgery | Middle grade on calla, consultant on calla | Variable |
| Vascular surgery | Middle grade resident, consultant on calla | Middle grade resident, consultant on calla |
| Anaesthetist | Middle grade resident, consultant on calla; ODP support within resuscitation | Middle grade resident, consultant on calla |
| Plastic surgery | Middle grade on calla, consultant on calla | Variable |
| Urology | Middle grade on calla, consultant on calla | Variable |
| Cardio/thoracic surgery | Middle grade on calla, consultant on calla | Variable |
| Maxillofacial/head and neck | Middle grade on calla, consultant on calla | Variable |
| Interventional radiology | Angio suite available 24/7a, consultant on calla | Variable |
| Dedicated trauma theatres, operating lists | Immediately available, ability for second if overwhelmed | Immediately available, ability for second if overwhelmed |
| Intensive care facilities | 24/7 | 24/7 |
| Critical care | Middle grade resident, consultant on calla | Middle grade resident, consultant on calla |
| Miscellaneous: | ||
| Education-prevention-research programmes | 100% | Variable |
| Clinical governance programmes | 100% | 100% |
| Interhospital transfer protocols | 100% | 100% |
| Trauma rehabilitation programmes | 100% | 100% |
aAvailable in 30 min.
CT = computed tomography; ODP = operating department practitioner.