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Over half of all major traumatic injuries are as a result of a road traffic accident; other common causes are industrial (or farming) accidents, sporting accidents, an assault, a fall from a great height and self-harm. There are around 20,000 major trauma cases in the UK every year and the average age of patients is just under 40 years old (The Trauma Audit and Research Network).
Common major traumatic injuries include multiple injuries to different parts of the body such as the chest, abdominal injury with a fractured pelvis; spinal injury; damage to internal organs; severe burns; and knife and gunshot wounds. Major traumatic injury is the main cause of death of people under the age of 40 with survivors often suffering long-term disability. (The Lancet: Changing the system – Major trauma patients and their outcomes in the NHS (England 2008 -17). Major Trauma is sometimes referred to as poly trauma.
When people are admitted to hospital the severity of their injuries are assessed and scored. The body is divided into six sections and the injuries in each section are given a scoring of between 1-6 (1 Minor and 6 Unsurvivable). The three highest injury scores (taken from three different regions of the body) are squared and added together to give a total score on the Injury Severity Scale. Anyone with a score of 16 or more is assessed to have a major traumatic injury.
Major trauma patients have complex injuries, often referred to as poly trauma. These people need expert care to have the best chance of surviving and recovering. This is a unique group of patients whose needs are complex and extend way beyond their physical injuries and limitations.
In 2012 the first 21 Major Trauma Networks (MTNs) were established in order to provide an improved pathway of clinical care for patients with major traumatic injury with the aim of saving more lives and reducing disability - sometimes referred to as Improving outcomes. MTNs comprise of a collection of service providers, including ambulance and air ambulance services, a Major Trauma Centre (usually a large acute city-based hospital) and general hospitals (known as Major Trauma Units) within a defined region.
A Major Trauma Centre (MTC) is a consultant-led service, based in a large hospital, which provides the full range of specialist services needed to treat major trauma patients, including emergency medicine, vascular, orthopaedic, plastic, spinal, maxillofacial and cardiothoracic surgery, neurosurgery and intervention radiology.
There are currently 27 MTNs in England each with a Major Trauma Centre. In 2018 NHS England reported that the lives of an additional 1,600 people had been saved since the creation of the MTCs due to the specialist care provided, combined with more comprehensive prescription for rehabilitation, although this is not consistent.
When the emergency services are called out, patients are assessed by ambulance staff at the scene of the incident. They are then taken by ambulance (or air ambulance) to the nearest Major Trauma Centre (MTC) if and when it is safe to do so. Some patients need a lot of medical intervention at the scene of their incident or accident before being taken to hospital. At the MTC patients are cared for by an on-site team, including experts in diagnostic tests, trauma injuries and brain surgery.
If a patient needs to be stabilised first (within a hospital) and the nearest MTC is further than 45 minutes away, they may be taken to a Major Trauma Unit - a hospital that is part of the Major Trauma Network - for immediate treatment before being transferred on to the MTC.
Once admitted to the MTC patients are assessed immediately and treated by a full specialist trauma team and often receive care over a period of weeks, typically involving orthopaedic, neurological and reconstructive surgery. They will also receive care from the wider trauma team including physiotherapists, psychologists, where services are available, occupational therapists and speech therapists.
Being ‘traumatised’ by an accident or event is normal and most people will recover with time. For some, the severity of the event may be difficult to process and the psychological damage can affect people in different ways.
Some common psychological symptoms include:
If you are experiencing a number of these symptoms you may be referred to the clinical psychology team who will undertake a full assessment of your needs and offer you a programme of treatment tailored to your particular needs.
This may include:
Trauma Focussed Cognitive Behavioural Therapy (CBT) helps address post-traumatic stress and emotional needs caused by traumatic events. TF-CBT provides patients with the tools to help process the traumatic event, in order to help them feel less anxious as a result of what has happened to them in the past.
A technique known as Eye Movement Desensitisation and Reprocessing (EMDR) involves the therapist sitting close to you and passing their hand back and forth across your field of vision whilst talking about their traumatic incident. This helps to integrate their traumatic memory into the brain where memories can be recalled in a less traumatic way. Research has shown that EMDR therapy is highly effective for patients with post-traumatic stress disorder.