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Table 1 Calendar of related past events

From: Trauma networks: present and future challenges

Source, year Statement Recommendation
Osmond-Clark H, 1961-1975
'Casualty department' staffed by casualty officers, usually senior house officers (SHOs) who had been qualified for 1 or 2 years. Senior cover was negligible. Tripartite scheme of peripheral casualty units, DGH accident centres and a regional major injury unit serving a population of 1 to 2 million
Cales RH and Trunkey DD, 1985 [14] Effect of a regional trauma system in reducing trauma mortality (USA) Use of 'preventable trauma deaths' as an evaluation tool of effectiveness
RCSE report, 1988 [15] Great discrepancy and deficiencies in existing emergency services. Serious deficiencies in the management of seriously injured patients. Establishment of trauma centres. Introduction of ATLS in the UK. Three pilot trauma centres in the UK (Royal London Hospital, the John Radcliffe Hospital in Oxford and North-Staffordshire Hospital in Stoke).
Anderson ID, 1988 [16] Preventable trauma deaths over 33% in England and Wales Need for changes in trauma-related services
BOA report, 1989 [17] Too many small units and too few consultants with a special interest in trauma care. Considerable resource implications of trauma centres (American model). Services should be concentrated. Need for expansion of consultant numbers.
Redmond AD, 1991 [18] First trauma centre in the UK (North Staffordshire Hospital Centre). Cost effectiveness and appropriateness evaluation. Use of pilot programmes to template needed changes
NAO report, 1992 [19] Deficiencies in NHS Accident and Emergency (A&E) Departments in England Information and Actions are required. Early and continuing improvements are needed. How trauma audit should be taken forward.
BOA report, 1992 [20] Review of 263 hospitals in the UK identified deficiencies in staff and equipment. Trauma services had not kept pace with technical advances. Many units were too small to sustain an adequate standard of care. Need for Regional Trauma Centre with its multidisciplinary arrangements. Set standards for the facilities required in a DGH. Rapid transfer to suitable hospital. Direct involvement of senior clinicians.
MTOS Study, Yates DW et al., 1992 [21] Initial resuscitation by junior staff in more than 50% of the cases. Delays in providing experienced staff and timely operations. Mortality varies inexplicably between hospitals. Significantly higher mortality rate for blunt trauma than in the US. Reformation of Trauma Services. Early senior staff involvement.
UK-TARN formation, 1993 [22] Creation of Data Collection Network related to trauma Recording performance and allowing the rationalisation of implemented changes to the trauma services
Rowley DI, 1993 [23] Lack of A&E consultants (21%). Lack of vital trauma associated specialties (80%). Lack of intensive care facilities (6%). Reformation of trauma services. Early senior staff involvement.
Nicholl J and Turner J, 1997 [24] Evaluation of pilot trauma centre and regional network showed modest reductions in mortality Greater integration along the entire trauma care pathway is the priority
BOA report, 1997 [25] Lower quality of care in comparison to countries such as Germany, Switzerland and the USA An integrated network approach to treating trauma patients. Integrated approach based upon a hub and spoke model.
BOA and RCSE joint report, 2000 [26] Current system does not assess the quality of life of those that survive. Only 50% of Trusts subscribe to TARN. Need for nationally coordinated standards of care. Need for systematic audit. Need for the development of outcome measures. Need for geographical trauma systems. Need for a strategy for rehabilitation.
Lecky FE, et al., 2002 [27] Lack of significant improvement in case fatality reduction between 1994 and 2000 according to the UK-TARN data  
NAO report, 2004 [28] Trauma audit has been improved through the establishment of TARN. Still scope for this work to be developed at a regional level Further expansion of the national TARN network. Development of Regional services.
NCEPOD report, 2007 [6] Deficiencies in both the organisational and clinical aspects of trauma care. Organisation of prehospital care, trauma team response, seniority of staff involvement and immediate in-hospital care was found to be deficient. Less than good care for 60% of reviewed major trauma patients. Need for designated Level 1 trauma centres. Ensure that a trauma team is available 24/7. A consultant must be the team leader for the management of the severely injured patient.
Lord Darzi's London report, 2007 [29] Review of London's healthcare identified stark of inequalities in health outcomes and the quality and safety of patient care not as good as it could, and should, be A trauma system should be put into operation within London. Integration of hospital and prehospital care. Bypass protocols need to be traduced taking the most seriously ill directly to trauma centres.
Lord Darzi's report, 2008 [30] Review of the NHS identified compelling arguments for saving lives by creating specialised centres for major trauma. SHA are asked to begin considering major trauma services. Create specialised centres for major trauma. Development of regional plans from strategic health authorities
RCSE report, 2009 [31] Without regionalisation, trauma mortality and morbidity in the UK will remain unacceptably high. The likelihood of dying from injuries has remained static since 1994 despite improvements in trauma care, education and training. Individual SHAs need to interpret the guidance to meet their own needs. There is no 'fit-all' scenario. Further development is urgently needed regarding areas as paediatric trauma care, burns care and rehabilitation services.
Professor Keith Willett, 2009 Department of Health appoints a National Clinical Director for Trauma care for the first time. National leadership for the implementation of regional trauma networks in England. Commissioning, audit, modelling, metrics, standards, critical care capacity, interventional radiology, rehabilitation, behavioural change, workforce, and training needs.
Dr Fiona Moore, 2009 Healthcare for London appoints London's first Trauma Director Responsible for leading the implementation of new specialist trauma networks across the capital
NAO report, 2010 [19] Significant data gaps and a lack of formalised systems remain. Still 59% of hospitals delivering trauma care participate in UK TARN. Major trauma care cannot be delivered cost effectively by all hospitals. Only one hospital has consultant lead services 24/7. A total of 64% of major trauma patients do not receive specialist care. Unacceptable variations in mortality rates, depending on where and when a person receives treatment. Lack of adequate data on level of rehabilitation services. Current funding arrangements do not reflect the actual trauma costs. SHA to develop regional trauma networks. Designation of hospitals suitable to receive major trauma cases. The DoH to review the financial levers of delivery of major trauma care.
London Network, 2010 [32] Initiation of the first comprehensive Trauma Network of the UK. Major Trauma Centres: The Royal London Hospital (Whitechapel), St George's Hospital (Tooting), King's College Hospital (Denmark Hill) and St Mary's Hospital (Paddington). Act also as a template for the development of the Regional Trauma Networks across the UK
Davenport DA, et al., 2010 [33] The effect of the reform of trauma services at RLH and the introduction of a MDT trauma service in 2003 was identified to have reduced preventable deaths from 9% to 2%, and secondary transfer mortality by 53% versus the national average. Implementation of a specialist trauma service and performance improvement programme is associated with rapid reductions in mortality for the severely injured. Future national major trauma centres should be specialist hospitals, not simply hospitals with specialties
East Midlands Network, 2011 Nottingham to be the first major trauma centre to start functioning outside London Act also as a template for the development of the Regional Trauma Networks across the UK
  1. BOA = British Orthopaedic, Association, DGH = District General Hospital, DoH = Department of Health, MDT = multidisciplinary team, MTOS = Major Trauma Outcome Study, NAO = National Audit Office, NCEPOD = National Confidential Enquiry into Patient Outcome and Death; NHS = National Health Service; RCSE = Royal College of Surgeons of England; RLH = Royal London Hospital; SHA = Strategic Health Authorities; TARN = Trauma Audit and Research Network.