Health: A real life-saver in Stoke: An experimental trauma centre has cut deaths among patients by up to half. Stanley Slaughter reports

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IT WAS a familiar accident: a 16-year-old boy cycling to school, knocked down by a car on a busy main road. When the ambulance team reached him he was unconscious, with severe head injuries, a broken thigh and other lesser injuries.

But, in a twisted way, fate was smiling on the teenager. The accident happened in Stoke-on-Trent, near the North Staffordshire Royal Infirmary, where Britain's first-ever trauma centre had just opened for a three-year trial. He was taken directly there and eventually, over months, made a full recovery. Two years on, he has just sat his A-levels.

Dr Anthony Redmond, one of the six consultants who run the centre, admits that this boy's chances 'were very much improved by the system we have in operation'.

Two-thirds of the way through its trial, the trauma centre, which serves the north and West Midlands, has cut deaths of its patients by between 30 and 50 per cent. It has also shortened the hospital stay of those who recover. Its success has attracted government praise and demands for a network of such centres across the country. The experiment has also brought doctors from America to study it.

In the Eighties, there was increasing concern about how people with life-threatening injuries - usually from car crashes - were being treated. Many, perhaps up to 30 per cent, were dying needlessly. The Royal College of Surgeons produced a report in 1988 that recommended the setting up of trauma centres. In response, the Department of Health selected Stoke to run such a centre for three years, providing pounds 2.4m in funding.

The six consultants, four in emergency medicine and two in anaesthetics, were selected and are contracted to work on a rolling rota to guarantee that a consultant is in the hospital at all times. 'You sleep there. That is unique in Britain. No other hospital does that or has ever done that,' said Dr Redmond, who is a consultant in emergency medicine and senior lecturer at Keele University in emergency and disaster medicine.

The trauma centre at Stoke has been grafted on to the existing casualty unit, unlike the American specialied units that are often housed in separate buildings and only half used.

'There have been no new buildings. You would not recognise it as any different from a well-equipped accident and emergency unit,' Dr Redmond said. 'What we have actually done is set up a trauma unit that is fully integrated into the normal service.'

Because the centre is based in a general hospital it can call on experienced consultants in all specialities except major burns, spinal injuries and some liver damage, which are handled by regional centres elsewhere in the West Midlands.

'Many people thought we would have a separate, formal centre reserved for trauma patients, but we have deliberately not done that. It is a practical solution for other hospitals to follow,' Dr Redmond said.

But why are these centres needed when traditional casualty units have apparently coped well in the past?

People injured in a car crash are likely to have multiple injuries, including damage to their head and chest, as well as tissues. 'Normally you would take them to the hospital where the specialist for the most severe injury is based. It is not the optimum, as you cannot decide which hospital this is until you have looked at the injuries,' Dr Redmond said.

Ambulance staff and paramedics have been briefed. Increasingly, they contact the centre for advice and take the seriously injured patients directly to it, even if it is not the nearest casualty department.

There are three patterns of death in road accidents: those who die instantly, those who die within a few hours and those who die weeks later.

The cause of death for the second group is usually loss of blood or choking from blocked airways. These patients can be saved with specialist surgery, provided treatment is given rapidly and they are not moved to another hospital. The deaths in the third category are mainly from organ failure, usually caused by blood loss or oxygen starvation immediately after the accident. Dr Redmond and his colleagues argue that such deaths can be reduced if early care is improved.

Not all doctors are in favour of special trauma centres. One argument is that treating all traumatically injured patients at a special centre means that many doctors will never experience emergency medicine and be less skillful as a result.

Dr Redmond dismisses this: 'I would leave it to the general public to decide what is more important: the facilities available for the injured patient or the quality of the job for the person who works there.'

The second argument is that such centres would threaten ordinary accident units. But major traumatic injuries are relatively rare. The trauma centre deals with only 350 a year while casualty units deal with several thousand cases - including heart attacks, strokes and drug overdoses, many of which are equally life threatening.

The Stoke centre invites doctors from surrounding hospitals to spend time with the team to make them feel part of the whole system. Paramedics will be based in the centre, helping the staff when not out on a call.

The Stoke experiment is due to end in March, after which time researchers from the Department of Public Health Medicine at Sheffield University will evaluate its performance. But with the worldwide attention the centre has already received, plus calls by Royal College of Surgeons for a network of such centres across the country and the dramatic cut in deaths in region, trauma centres look here to stay.

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