LMTS CLINICAL GUIDANCE

Paediatric Trauma Care Guidelines

Trauma is the leading cause of death and disability for children and adolescents. Timely, expert care is essential to ensure optimal recovery after paediatric injuries. The pan London paediatric trauma group comprises multi-disciplinary professionals with expertise and interest in caring for injured children and their families. This collaborative guidance document and more detailed trauma manual are available to anyone managing paediatric trauma across greater London.

Paediatric Trauma Guidelines here

Paediatric Trauma Manual here

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 service. 

Download LAS Major Trauma Triage Tool (Adults)

Download LAS Major Trauma Triage Tool (Children)

Download LAS Hospital Transfer Flowchart

Older 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 increasingly older, 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 older patients admitted to major trauma networks.

The pan London older 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, and may be of interest to those working at Local Emergency Hospitals. 

Download Here: Pan London Major Trauma System Management of the Older Trauma Patient. Third Edition

REBOA guidance

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 Trauma guidance

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 guidance

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

During the COVID-19 pandemic, injured patients who would normally be managed by the MTC Trauma Services may be cared for at local trauma units/hospitals, or by non-trauma trained clinical teams.  On this page we share some trauma resources which may be useful during the pandemic.

TRAUMA TERTIARY SURVEY: guidance for clinicians during COVID19 (click here)

This guidance outlines the principles of the trauma tertiary survey for clinicians working with trauma patients during the coronavirus pandemic (with thanks to Jo Shepherd and Tom Konig)

Shared Timeout Tool Template
 
During the COVID-19 pandemic, some clinicians at the Royal London Hospital (RLH) began using a protocolled method of team meetings, loosely based on the WHO surgical safety checklist. It’s called the team timeout tool.

In settings where staff work is shift-based & handovers of care are frequent, patient and staff safety can easily be compromised, even where teams are high-functioning. 
 
In an environment with exactly these parameters, the Paediatric Emergency Department within the Children’s Hospital, this was recognised, and the tool stemmed from a desire to unite discussions about aspects of patient care that are frequently updated, around a series of headings: people — process — and flow.
 
Iterative changes and improvements to the flowchart have been made, and much has been learned from different teams’ use of the tool - culminating in the RLH Trauma Service adapting it for their own needs. The headings have been designed to be generic, so that the bullet points can be adapted to local needs.
 
We would be delighted for you to use it too, and share your adaptations.

Please find all iterations at bit.ly/SharedTimeout.

The tool's creator (Chris Odedun) would be grateful if you could keep in touch by completing the webform at bit.ly/sharedtimeout (please note lack of capitals as it brings you to a different form!)

Find the Time out Tool here
 

Guidance for ED RESUSCITATIVE THORACOTOMY

Please find the guidance here

 

Guidance for CHEST DRAIN INSERTION

Please find the guidance here

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