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Trauma networks and rural trauma
t h e s u r g e o n x x x ( 2 0 1 6 ) 1 e2
Available online at www.sciencedirect.com
ScienceDirect The Surgeon, Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland www.thesurgeon.net
Correspondence: Letter to the Editor
Trauma networks and rural trauma
Keywords: Trauma MTC Scotland
Dear Sir, In their recent editorial, Jansen and colleagues outline the proposed ‘national network for the delivery of trauma care’.1 Geographical realities will require a level of flexibility both within and between the networks associated with individual Major Trauma Centres (MTCs). The suggested distinction between ‘urban’ and ‘rural’ Trauma Units is in reality blurred. It is entirely possible, as is the case for the example quoted (Wishaw General), for the Trauma Unit (TU) to be within 45 min of a MTC but that many of the major trauma cases being brought from the catchment area of the TU, will be well over 45 min travel from the MTC. Such cases will thus present to the Trauma Unit for secondary transfer. In effect Scotland has two models of secondary care. Most of the population is covered by the conventional, ‘District General Hospital’ (DGH) model with a range of on-site services including Emergency Medicine consultants and Intensive Care. Those living in more remote and rural areas have an alternative model, six ‘Rural General Hospitals’ (RGHs) in Oban, Fort William, Stornoway, Wick, Kirkwall and Lerwick, each have a less diverse range of specialties but will all see small but significant numbers of major trauma cases relating e.g. to local industry, tourism and rural road trauma. Numbers are difficult to quantify exactly as at present none of these units contribute the Scottish Trauma Audit Group (STAG).2 These hospitals endure significant recruitment and retention staffing problems3 and will require tailored support as part of integration into a Trauma network. Participation in STAG would be essential. More remote areas are covered by GP-led community hospitals, in many areas these sites receive emergencies and thus may be confronted with major trauma, albeit rarely.
DOI of original article: http://dx.doi.org/10.1016/j.surge.2016. 03.002.
Similar considerations apply for isolated General Practitioners, particularly on the smaller islands.4 In reality: Transfers from remote and rural sites are inevitably more complex in terms of logistics than transfers from a DGH. Triage is often influenced by transport logistics, adverse weather and the availability of Intensive Care beds at referral centres. Such factors can cause significant delays. Underpinning the successful implementation of a network is the effectiveness of retrieval/transfer. This requires to be resourced and to have effective clinical governance in place. For a number of centres the nearest ‘TU’ will be part of one MTC network but the rural centre may be closer to a different MTC. Direct transfer of the most serious cases to the nearest MTC is the most sensible option. On occasion prevailing circumstances may dictate that patients are transferred to other than the closest MTC. Thus it is clear that a high degree of cooperation between the various MTC networks will be essential. Practical considerations will blur both the roles of hospitals and the boundaries between networks, Particular attention to the support provided to these rural units will be necessary. Open communication, common sense principled by patient need, flexibility and adaptability will be required to deliver quality care to major trauma patients who present to rural centres, to ensure that such patients are not disadvantaged. Yours sincerely,
references
1. Jansen JO. Trauma care in Scotland: the role of major trauma centres, trauma units, and local emergency hospitals. Surg 2016. http://dx.doi.org/10.1016/j.surge.2016.03.002.
Please cite this article in press as: Inglis A, et al., Trauma networks and rural trauma, (2016), http://dx.doi.org/10.1016/ j.surge.2016.09.002
2
t h e s u r g e o n x x x ( 2 0 1 6 ) 1 e2
2. www.stag.scot.nhs.uk/docs/health-boards-STAG-audit-2015edit.pdf [Accessed 6 August 2016]. 3. www.heraldscotland.com/opinion/14449151.Herald_View__ Saving_surgery_in_Scotland_s_rural_communities/ [Accessed 6 August 2016]. 4. www.gov.scot/Resource/Doc/304168/0095438.pdf (Table 3.2 p. 14 and Figure 3.1 p. 15), [Accessed 6 August 2016].
Andrew Inglis* South Glasgow University Hospital, UK EMRS, UK University of Glasgow, UK John S. Abraham Lorn and Islands Hospital, Oban, UK
Peter W. Johnston Department of Pathology, Aberdeen Royal Infirmary, UK *Corresponding author. c/o Critical Care, South Glasgow University Hospital, University of Glasgow, UK. Available online xxx 1479-666X/$ e see front matter © 2016 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.surge.2016.09.002
Please cite this article in press as: Inglis A, et al., Trauma networks and rural trauma, (2016), http://dx.doi.org/10.1016/ j.surge.2016.09.002
Available online at www.sciencedirect.com
ScienceDirect The Surgeon, Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland www.thesurgeon.net
Correspondence: Letter to the Editor
Trauma networks and rural trauma
Keywords: Trauma MTC Scotland
Dear Sir, In their recent editorial, Jansen and colleagues outline the proposed ‘national network for the delivery of trauma care’.1 Geographical realities will require a level of flexibility both within and between the networks associated with individual Major Trauma Centres (MTCs). The suggested distinction between ‘urban’ and ‘rural’ Trauma Units is in reality blurred. It is entirely possible, as is the case for the example quoted (Wishaw General), for the Trauma Unit (TU) to be within 45 min of a MTC but that many of the major trauma cases being brought from the catchment area of the TU, will be well over 45 min travel from the MTC. Such cases will thus present to the Trauma Unit for secondary transfer. In effect Scotland has two models of secondary care. Most of the population is covered by the conventional, ‘District General Hospital’ (DGH) model with a range of on-site services including Emergency Medicine consultants and Intensive Care. Those living in more remote and rural areas have an alternative model, six ‘Rural General Hospitals’ (RGHs) in Oban, Fort William, Stornoway, Wick, Kirkwall and Lerwick, each have a less diverse range of specialties but will all see small but significant numbers of major trauma cases relating e.g. to local industry, tourism and rural road trauma. Numbers are difficult to quantify exactly as at present none of these units contribute the Scottish Trauma Audit Group (STAG).2 These hospitals endure significant recruitment and retention staffing problems3 and will require tailored support as part of integration into a Trauma network. Participation in STAG would be essential. More remote areas are covered by GP-led community hospitals, in many areas these sites receive emergencies and thus may be confronted with major trauma, albeit rarely.
DOI of original article: http://dx.doi.org/10.1016/j.surge.2016. 03.002.
Similar considerations apply for isolated General Practitioners, particularly on the smaller islands.4 In reality: Transfers from remote and rural sites are inevitably more complex in terms of logistics than transfers from a DGH. Triage is often influenced by transport logistics, adverse weather and the availability of Intensive Care beds at referral centres. Such factors can cause significant delays. Underpinning the successful implementation of a network is the effectiveness of retrieval/transfer. This requires to be resourced and to have effective clinical governance in place. For a number of centres the nearest ‘TU’ will be part of one MTC network but the rural centre may be closer to a different MTC. Direct transfer of the most serious cases to the nearest MTC is the most sensible option. On occasion prevailing circumstances may dictate that patients are transferred to other than the closest MTC. Thus it is clear that a high degree of cooperation between the various MTC networks will be essential. Practical considerations will blur both the roles of hospitals and the boundaries between networks, Particular attention to the support provided to these rural units will be necessary. Open communication, common sense principled by patient need, flexibility and adaptability will be required to deliver quality care to major trauma patients who present to rural centres, to ensure that such patients are not disadvantaged. Yours sincerely,
references
1. Jansen JO. Trauma care in Scotland: the role of major trauma centres, trauma units, and local emergency hospitals. Surg 2016. http://dx.doi.org/10.1016/j.surge.2016.03.002.
Please cite this article in press as: Inglis A, et al., Trauma networks and rural trauma, (2016), http://dx.doi.org/10.1016/ j.surge.2016.09.002
2
t h e s u r g e o n x x x ( 2 0 1 6 ) 1 e2
2. www.stag.scot.nhs.uk/docs/health-boards-STAG-audit-2015edit.pdf [Accessed 6 August 2016]. 3. www.heraldscotland.com/opinion/14449151.Herald_View__ Saving_surgery_in_Scotland_s_rural_communities/ [Accessed 6 August 2016]. 4. www.gov.scot/Resource/Doc/304168/0095438.pdf (Table 3.2 p. 14 and Figure 3.1 p. 15), [Accessed 6 August 2016].
Andrew Inglis* South Glasgow University Hospital, UK EMRS, UK University of Glasgow, UK John S. Abraham Lorn and Islands Hospital, Oban, UK
Peter W. Johnston Department of Pathology, Aberdeen Royal Infirmary, UK *Corresponding author. c/o Critical Care, South Glasgow University Hospital, University of Glasgow, UK. Available online xxx 1479-666X/$ e see front matter © 2016 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.surge.2016.09.002
Please cite this article in press as: Inglis A, et al., Trauma networks and rural trauma, (2016), http://dx.doi.org/10.1016/ j.surge.2016.09.002