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Table 2 Essential characteristics of hospitals delivering trauma care in the Regional Trauma Network (RTN) era

From: Trauma networks: present and future challenges

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%

  1. aAvailable in 30 min.
  2. CT = computed tomography; ODP = operating department practitioner.