London Ambulance Service - Major Trauma Triage and Transfers

The London Ambulance Service NHS Trust (LAS) assesses, treats and transports seriously injured patients to one of four specialist major trauma centres (MTCs) in the Capital. Evidence from around the world shows that rapidly conveying these patients to centres with the necessary expertise and equipment helps reduce morbidity and mortality. Major trauma has a relatively low incidence, and constitutes less than 0.5% of the LAS workload.

LAS clinicians aim to identify the most seriously injured patients quickly using the London Major Trauma Decision Tool a flowchart that allows them to use the information they have available in the pre-hospital environment to triage patients likely to benefit from care at a MTC. The accepted definition of major trauma is an Injury Severity Score (ISS) greater than 15. The score can only be determined after a detailed assessment in hospital, and with the knowledge of the interventions undertaken and the outcome of the patient. As such it is recognised that the number of patients identified as potential major trauma by LAS clinicians will be higher than those subsequently assessed with an ISS of more than 15. However, the clear criteria in the decision tool should prevent patients who can be treated at a local ED travelling potentially longer distances to an MTC and negatively affecting the MTCs' capacity to treat those needing their services.

Download LAS Major Trauma Triage Tool (Adults)

Download LAS Major Trauma Triage Tool (Children)

Download LAS Hospital Transfer Flowchart

Elderly Trauma Care Guidelines

Nationally, the over 65s are the fastest growing age group in the UK, and the Office for National Statistics estimate that by 2040 one in four people in the UK will be aged 65 or over.

The Trauma Audit Research Network (TARN) reported that major trauma patients in England and Wales are becoming more elderly, and low level falls are now a leading cause of severe injury. However there are currently few clinical guidelines which specifically focus on the needs of injured elderly patients admitted to major trauma networks.

The pan London elderly trauma group comprises multi-disciplinary professionals with expertise and interest in managing older injured patients. This group have produced clinical guidance for the management of elderly trauma patients within Major Trauma Centres and Trauma Units. Clinical commissioning standards for the care of this group of patients have been proposed within the guidelines, for discussion with the National Clinical Reference group and other key stakeholders.

Download the guidelines for the management of elderly trauma patients

REBOA

REBOA (resuscitative endovascular balloon occlusion of the aorta) is currently being performed by London’s air ambulance for exsanguinating non-compressible haemorrhage. Given the extremely shocked state of these patients they are likely to present to any of the London MTCs and require rapid definitive haemorrhage control and balloon deflation. A working knowledge of REBOA is required and the hospital system prepared to ensure safe, smooth and rapid transition from pre-hospital to definitive care. Pan-London MTC guidance for patients with REBOA in situ can be downloaded here.

NICE

The National Institute for Health and Care Excellence (NICE) has developed five pieces of guidance relating to trauma. Each piece of guidance focuses on a different aspect of trauma care, specifically:

  • Major trauma
  • Major trauma services
  • Fractures
  • Complex fractures

The NICE pathway for major trauma guidance can be found here

NICE guidelines on head injury can be found here.

BOAST

The British Orthopaedic Association and British Association of Plastic, Reconstructive and Aesthetic Surgeons set standards for trauma diagnosis and management relating to orthopaedics and reconstructive surgery.  These are called BOAST(s) and can be found here.  

SPINAL INJURIES MANAGEMENT

The Multidisciplinary Association of Spinal Cord Injury Professionals (MASCIP) provides guidelines to improve standards of care for people with SCI.  The guidelines for care of older people are here, and guidelines for management of neurogenic bowel dysfunction can be found here

TARN

The Trauma Audit & Research Network, based at Manchester University provides outcome comparisons and a host of other data for all trauma centres and units in the UK. The publicly facing website contains performance comparison data for all trauma receiving hospitals in the UK.

QUALITY SURVEILLANCE PROGRAMME

The Quality Surveillance Team (QST), formerly National Peer Review Programme, lead an Integrated Quality Assurance Programme for the NHS and is part of the National Specialised Commissioning Directorates, Quality Assurance and Improvement Framework (QAIF). The trauma programme involves both self-assessment by Trauma teams and external reviews of teams conducted by professional peers, against nationally agreed “quality measures”.

Earlier national review reports can be downloaded from the links below:

National Peer Review Report of Trauma Networks, Centres and Units in England - 2015

National Peer Review Report of Trauma Networks, Centres and Units in England- 2014

 

 

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