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Logo of bmjThis ArticleThe BMJ
BMJ. 2007 November 24; 335(7629): 1067.
PMCID: PMC2094192

Hospitals without appropriate expertise should not offer trauma care

Less than half of people who sustain serious injuries receive good care before they arrive in an emergency department, a new report says. And it says that such failings in care continue once the patients have arrived at hospital.

A team approach is needed to deliver effective care for trauma patients in the same way that cancer services teams have worked across healthcare disciplines to improve outcomes, said Simon Carter, one of the report's authors.

“We need to see significant improvements made now to pre-hospital and hospital trauma care in order to prevent the unnecessary death of young patients, with its tragic consequences for families, not to mention the economic cost to the nation,” he added.

The National Confidential Enquiry into Patient Outcome and Death (NCEPOD) looked at 795 patients who had a severe injury between February and April 2006 and who were treated in hospitals in England, Wales, Northern Ireland, and the offshore islands. Most of the injuries were the result of road traffic incidents or falls from a height.

The report found that 20% of hospitals did not have a dedicated trauma team and that more than half of patients who needed neurological services were taken to a hospital without such facilities. Some hospitals should consider opting out of providing trauma care because they do not have the expertise to provide the required level of care, said George Finlay, a clinical coordinator at NCEPOD and one of the authors of the study.

“We need to look at how we can organise trauma care on a regional basis. For example, we need protocols for ambulance crews to bypass the nearest hospital if this is not the most appropriate hospital to give the best care to the particular patient,” he said.

Trauma is the leading cause of death in the first 40 years of life and is also a large socioeconomic burden: for every death from trauma there are two survivors with a serious or permanent disability. Hospitals that deal with more than 20 severe trauma cases a week have a better quality of care, he explained.

The report found other failings once patients have reached hospital. Medical staff often did not appreciate the severity of the injuries, displayed little urgency in caring for them, and made incorrect clinical decisions.

The report calls for all hospital trusts to have 24 hour trauma teams with a consultant in charge of managing the care of severely injured patients. Trauma services may need to be reconfigured in some regions and should consider putting a doctor in with the ambulance crew in cases of trauma. The report also recommends that patients with severe head injuries should undergo computed tomography within one hour of admission to hospital and that standardised patient report forms should be used across ambulance trusts.

Another of the study's authors, Ian Martin, lead clinical coordinator at NCEPOD, said, “Patients with severe head injury require immediate airway control and early arrival at a centre with on-site neurosurgical services. We would like doctors to be involved in the care of severe trauma patients from the pre-hospital stage.” 


Trauma: Who Cares? can be seen at

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