We can make a difference to trauma patients

Anglia One helicopter in flight 1

We, as pre-hospital clinicians, have the opportunity to make a real difference to trauma patients. At the recent East Anglian Air Ambulance clinical governance day, Simon Lewis, Clinical Director of the East of England Trauma Network gave a presentation about the regional trauma network and the importance of our role. The clinical governance days are an opportunity to share learning and reflections related to patients and the whole system of pre-hospital care. There is also an opportunity to have speakers and teaching sessions.

We need to identify trauma patients earlier and improve our use and reporting of the trauma triage tool (TTT). The TTT is designed for use by any grade of clinician and should be reported on channel 202 via your Airwave handset to the critical care desk (CCD), which will prompt a series of actions.

All of these actions are designed to ensure the pre-hospital and in-hospital care provided to the patient are timely and appropriate, and all aim to achieve the best possible outcome for the patient. CCD can also provide logistical and clinical support, clinician to clinician, when dealing with these complex patients. They are the gate holders to extra help if needed, and can activate medical teams, BASICs responders and HART, all of whom may be able to assist you with caring for your patient.

There have been some issues in the past around the use of the TTT:

  • Knowing when to apply it: There is no right or wrong answer here. If you suspect the patient has a significant traumatic injury/injuries, you should apply the tool, using the anatomical and physiological parameters to establish if the patient is positive or negative. 
  • Why report triage negative patients? The triage tool is fairly new, and as yet, the trauma network has been unable to prove if it works or not. To do this analysis (sensitivity and specificity) the network needs to know about all of the patients who have been triaged negative, also via channel 202, to make sure they were negative, as well as looking at those who were triaged positive to make sure they were positive.
  • I have lost my triage tool: Please speak to your local management team, they should have copies of these, and can order stock if your area has run out.

Another issue highlighted was how we can make a real difference through use of tranexamic acid (TXA) but aren’t using it as often as we could. TXA is indicated for all suspected bleeding (>12yrs) in the context of major trauma (excluding isolated head injury) where the patient is in a shocked state (HR >110 or SBP of <90mmHg).

There is a strong evidence base to support this practice (CRASH-2 trial) which showed a 32% reduction in death due to bleeding when TXA was given within one hour. Your major trauma patient may well be coagulopathic and you could make a massive difference to their outcome by giving it.

More info on the Trauma Network can be found on their website at www.eoetraumanetwork.nhs.uk.

Published 14th August 2014 

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