What is Major Trauma?
Patients with major trauma are those with serious, multiple injuries that require 24/7 emergency access to a wide range of clinical services and expertise.  For example, doctors may be required to attend to a patient with head and neck injuries, chest, pelvis and other bone fractures. Major traumas can happen as a result of many mechanisms such as:

• Road Traffic Collisions (RTC)
• Industrial accidents
• Falls
• Leisure activities

Access to the right service at the right time is crucial for survival. 

Improving Care for Major Trauma Patients
Before major trauma networks were set up, major trauma patients were helped through a 999 emergency ambulance response and taken to the nearest hospital emergency department for treatment. All of our South West hospitals with emergency departments treated trauma, although many transferred patients with severe injuries on to more specialised centres, sometimes outside of the region. This system was a general response service and there was no 24/7 specialist major trauma system in the region.

Working Together Saves Lives
Evidence shows that having a major trauma system can save 20% more lives every year. Research from the USA and Australia, which already have established Trauma Systems, tells us that patients with severe multiple injuries have a better chance of survival and recovery under a regional Major Trauma system,  where all acute hospitals and the ambulance service work together to provide an integrated response.

Our System
Following a rigorous assessment process, Derriford Hospital was designated as the Major Trauma Centre for the Peninsula Trauma Network, which covers all of Devon and Cornwall, by the South of England Strategic Health Authority.

The Peninsula Trauma Centre is supported by a number of trauma units which can stabilise patients who need to be transferred on to the major trauma centre or can look after less seriously injured patients. After an equally rigorous assessment process, the following hospitals were designated by the South of England Strategic Health Authority as Trauma Units:

• North Devon District Hospital
• Royal Cornwall Hospital, Treliske
• Royal Devon and Exeter Hospital
• Torbay Hospital

Benefiting Patients

• We are working to save more lives and significantly improve people’s chances of making the fullest recovery possible.
• We have a service that delivers the highest possible care for patients 24 hours a day, seven days a week.
• The most seriously injured patients are getting better access to the very specialised care they need.
• We are better able to manage most if not all cases of trauma in the south west, including less life-threatening and minor injuries, improving the care every patient in the region receives.
• Rehabilitation services are steadily improving with the aim of getting patients back to full active lives wherever possible.

How We Developed Our Major Trauma System

Assessed current provision
The programme team collected data on major trauma, on where and when it happens. They took into account the population in each part of the area, to help anticipate how many people will suffer from major trauma, what/where care will be needed. They took into account patient flows across the regional border, the region's unique geography and anticipated population growth. They also reviewed the strengths and weaknesses of the current services and asked our hospitals which level of service they wanted to provide. They mapped the catchment areas for services, based on a target 45-minute journey time and an agreed triage protocol, in order to develop the most effective system configuration.  We took into consideration journey times on both urban and rural roads, the effects of rush-hour traffic, proposed population expansion and the seasonal variations to both regional populations and traffic patterns. The information sources used include the TARN (the Trauma Audit Research Network); the South Western Ambulance Service; Hospital Episode Statistics and national reports.

Developed service models
Evidence tells us that normally one major trauma centre would be needed for the South West due to the population size, however because of the geography in the peninsula it has been agreed that two trauma centres are needed:

• One major trauma centre for the Severn Region at Frenchay Hospital in Bristol and one for the Peninsula region at Derriford Hospital in Plymouth.
• The Paediatric Trauma Centre for the region will also be Frenchay Hospital in Bristol although lifesaving treatments i.e. neurosurgery can be Undertaken at Derriford Hospital prior to transfer to Bristol.
• The four other acute hospitals in Barnstaple, Exeter, Truro and Torbay  will be the trauma Units that feed directly into the Peninsula Trauma Centre.
  

Set minimum standards for services in line with national guidance
We have specified minimum standards of care for all levels of service. For example, the major trauma centre must offer 24-hour access to a consultant-led major trauma team. Trauma units must provide selected trauma management with a consultant on call within 30 minutes. All providers must offer appropriate facilities for relatives and clear patient information.

How We Involved Stakeholders
The proposals stem from a review of health services in 2007 when 4,500 members of the public and 500 health and social care staff gave their views about what mattered to them. This was in response to Lord Darzi’s national NHS review: the Next Stage Review. From this, improving major trauma care was identified as a priority for the South West. The following organisations have all worked together to develop this new system:

• South of England Strategic Health Authority
• NHS Cornwall
• NHS Devon
• NHS Plymouth
• Plymouth Hospitals NHS Trust
• Royal Devon & Exeter NHS Foundation Trust
• Royal Cornwall Hospitals NHS Trust
• Northern Devon Health Care NHS Trust
• South Devon Healthcare NHS Foundation Trust
• South Western Ambulance Service NHS Foundation Trust
• Devon Air Ambulance
• Cornwall Air Ambulance
• BASICS
• Devon and Cornwall Oversight and Scrutiny Committees

All the work that representatives from the organisations have put into this project has helped to develop a trauma service that meets the needs and expectations of patients, their families and carers and will continue to inform the ongoing development and implementation of this new system.