• Defining major trauma: a literature review

      Thompson, Lee; Hill, Michael; Shaw, Gary (2019-06-01)
      Introduction: Major trauma in the elderly population has been increasingly reported over the past decade. Compared to younger populations, elderly patients may experience major trauma as a result of low mechanisms of injury (MOIs) and as a result, existing definitions for ‘major trauma’ should be challenged. This literature review provides an overview of previous conceptualisations of defining ‘major trauma’ and considers their utility in relation to the pre-hospital phase of care. Methods: A systematic search strategy was performed using CINAHL, Cochrane Library and Web of Science (MEDLINE). Grey literature and key documents from cited references were also examined. Results: A total of 121 articles were included in the final analysis. Predominantly, retrospective scoring systems, such as the Injury Severity Score (ISS), were used to define major trauma. Pre-hospital variables considered indicative of major trauma included: fatal outcomes, injury type/pattern, deranged physiology and perceived need for treatment sequelae such as intensive care unit (ICU) admission, surgical intervention or the administration of blood products. Within the pre-hospital environment, retrospective scoring systems as a means of identifying major trauma are of limited utility and should not detract from the broader clinical picture. Similarly, although MOI is often a useful consideration, it should be used in conjunction with other factors in identifying major trauma patients. Conclusions: In the pre-hospital environment, retrospective scoring systems are not available and other variables must be considered. Based upon this review, a working definition of major trauma is suggested as: ‘A traumatic event resulting in fatal injury or significant injury with accompanying deranged physiology, regardless of MOI, and/or is predicted to require significant treatment sequelae such as ICU admission, surgical intervention, or the administration of blood products’. Abstract published with permission.
    • Identifying pre-hospital factors which influence outcome for major trauma patients in a regional Trauma Network: an exploratory study

      Thompson, Lee; Hill, Michael; Davies, Caroline; Shaw, Gary (2016-09)
      Background Major trauma is often life threatening or life changing and is the leading cause of death in the United Kingdom for adults aged≤45 years. The aim of this exploratory study was to identify pre-hospital factors influencing patient outcomes for major trauma within the Northern Trauma Network. Method Secondary data analysis of a combined data set of pre-hospital audit data and patient outcome data from the Trauma Audit Research Network (n=1033) was undertaken. Variables included mechanism of injury, age, physiological indices, timings and skill mix. Principle outcome measures included Mortality data and Glasgow Outcome Scales. Results Glasgow Coma Scores proved a significant predictor of mortality in major trauma (p<0.00). Amongst other physiological indices, systolic blood pressure ≤90 mm Hg. was associated with both increased mortality (p≤0.004) and poorer morbidity (p≤0.021). Respiration rate <14/minute was also significantly predictive of morbidity (p≤0.03) and mortality (p<0.00). Prolonged response times to the most critically injured patients (p<0.031), and increasing casualty age were significantly associated with poorer outcomes. The attendance of a Doctor was significantly associated with increased mortality (p≤0.036) perhaps validating existing resource despatching practices. Predictors of positive outcomes included the presence of a Doctor when on-scene time ≤50 minutes (p≤0.015), crew arrival on-scene ≤10 minutes (p<0.046) and on-scene time ≤50 minutes (p<0.015). Conclusion These findings validate GCS, BP and Respiratory Rate values as valid triggers for transport to a Major Trauma Centre. Analysis of the interactions between arrival time, time-on-scene, skill mix and age demand further exploration but tentatively validate the concept of a ‘Golden Hour’ and suggest the potential value of a ‘load and go and play on the way’ approach. https://emj.bmj.com/content/emermed/33/9/e5.1.full.pdf This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ 10.1136/emermed-2016-206139.18
    • A service evaluation of the iTClamp™50 in pre-hospital external haemorrhage control

      Shaw, Gary; Thompson, Lee; Davies, Caroline (2016-09)
      Abstract published with permission. It has long been accepted that uncontrolled haemorrhage is a leading cause of early death in trauma patients, with the majority of deaths occurring in the pre-hospital setting. While most cases of haemorrhage can be dealt with using standard dressings, tourniquets and haemostatic agents, some anatomical areas such as the head, neck, axilla and junctional areas continue to be problematic, as it is challenging to apply tourniquets or trauma pressure dressings to these areas effectively. One device designed to overcome this issue is the iTClamp™50, which was the subject of a service evaluation by the North East Ambulance Service NHS Foundation Trust, from July 2014 to February 2016. Experienced paramedics stationed close to the participating major trauma centre were asked to evaluate the device with a view to obtaining a minimum of 20 cases of iTClamp use to determine its suitability. Paramedic participants were trained by the manufacturer before being provided with two iTClamps. After every application, the evaluating paramedic produced an unstructured reflective account and completed an evaluation questionnaire. Paramedics who used the iTClamp™50 found it enhanced their ability to quickly control external haemorrhage in difficult anatomical areas and could be used as part of a major haemorrhage control strategy. Overall, paramedics felt it was quick and easy to use following a short training session.