Activation of the trauma team is based on anatomical and physiological parameters. Mechanism of injury does not form the basis of the activation triage tool. A trauma team can be called at any stage of a patient’s journey. There is an automatic acceptance policy (Page 13). A copy of the South West Ambulance Service NHS Trust Major Trauma Triage Tool can be found on Page 45. Indications for Trauma Team Activation Anatomy: Unsafe airway Flail chest Penetrating injury to head, neck or torso Severe pelvic injury Major crush injury to torso or upper thigh Limb amputation Two or more long bone fractures Paralysis from spinal cord injury Burns over 20% or potential airway burns Abnormal Physiology: Respiration 30 or other signs of respiratory compromise Pulse 120 Systolic blood pressure <90 mmHg Systemic signs of shock Head injury with motor score ≤4 Special Circumstances Multiple patients Agreement between TTL and paramedics on scene Agreement between the TTL and Specialist Paramedics on SWAST’s Trauma Advice Line HEMS requested Secondary Transfer from Trauma Unit

The ethos is that this team manage the initial assessment, resuscitation, imaging and coordination of disposal be it theatre, ITU or ward for major trauma patients presenting to NBT. Each team member will have generic roles within this structure, as well as providing individual expertise. The aim is that a consistent and predictable trauma team response is provided to each trauma, where roles and responsibilities are well defined and adhered to by each member of the team. There is a switchboard test call at 10:00 and at 16:00 Call Activation 1. Following pre-alert from ambulance service the senior doctor and Band 7 on duty will decide whether trauma team is activated: decision supported by the use of trauma activation guidelines. 2. Ring x2222 3. State ‘trauma call’ 4. The TTL and Senior Nurse will carry out a situational appraisal of the department with the Duty ED lead to allocate appropriate bays and resources. 5. On arrival of patient the TTL must identify themselves to the lead pre-hospital clinician and receive handover. 6. The salient points of this handover will be written on the Trauma Board to prevent repetition of information, using the ATMIST handover formula – see Page 39. A sticker for ATMIST handover should be available and completed by the scribe. 7. Each member of the trauma team should fulfil their roles unless the TTL dictates otherwise. 8. Members of the trauma team must not leave resuscitation without discussion with the TTL.

Contact numbers for the trauma team at North Bristol Trust:

Trauma Team Leader Bleep 9745

Anaesthetist 3rd on Call Bllep 9033

ICU Registrar Bleep 9039

General Surgeon Reg on Call Bleep 9772 (Take) 9656 (Post-Take) Orthopaedic Reg On Call (SHO will hold bleep when SpR not on site) 9750 Radiology Registrar 9746 Haematologist 9433 Radiographer 9704 Trauma Nurse Co-Ordinator 9747, 9748, 9749 ED Nurse 1 ED Nurse 2 ED Nurse 3 ERA Porter 9567 Matron ED 9744 Senior nurse ED 9743 Receptionist 9742 Other specialities may be called as clinically indicated Neurosurgery Ext. 45726 Plastics 1311 Cardiothoracics Via switchboard @ University Hospitals Bristol and Weston

Present in ED or available within 5 minutes of notification. Start of Shift: Liaise with Lead Nurse, collect trauma bleep and TTL folder, take departmental situational report and meet with Trauma Team Nurse 1&2. Trauma Team Activation Pre-Hospital: Alert Call ‣ Take call / review call as details taken ‣ Take patient identifiers as available ‣ Decide with ED nursing shift lead whether to initiate trauma team activation ‣ Call Switchboard to initiate trauma call – an ETA is not required ‣ If patient is transferred by air then security and clinical site teams needs to be informed. In-Hospital Alert Call ‣ Can be initiated at any stage by the TTL for a patient within the Emergency Department. ‣ The decision to activate the trauma team is based on the expectation that the alerted team members will be present to receive the patient. There is no requirement for team members to ring the ED to discuss the case prior to the patient’s arrival. ‣ All team members receiving a trauma call are expected to alert their respective speciality teams of an incoming Trauma. ‣ (Thus theatre, radiology, ITU beds and blood product availability can be planned for by respective teams) Consider: ‣ Early notification to neurosurgery, plastic surgery, interventional radiology, cardiothoracic surgery, urology and vascular surgery as required. ‣ Massive transfusion protocol activation. ‣ Medical Photography

Pre-Arrival ‣ Add alert call details to Trauma Board and update trauma team. ‣ Lead resuscitation, coordinate staff and resources. ‣ Ensure personal introductions by team members and confirm roles. ‣ Ensure team wear personal protective equipment. Patient Reception ‣ Ensure resus clock started ‣ Co-ordinate ATMIST handover from Pre-Hospital Team – add details to Trauma Board. ‣ Co-ordinate transfer to Resus Trolley. ‣ Manage trauma team response. ‣ Make decisions in conjunction with team members and relevant specialists. ‣ Prioritise investigations and treatments. ‣ Ensure imminent life threatening conditions are treated and direct rapid transfer to CT or Theatre. Promote an environment of open communication with review of ongoing management priorities and plans, ensuring involvement of all team members. Aim for CT within 15 minutes unless reasons prevent this Consider CT in lieu of primary survey x-rays in some cases see - “Imaging in Trauma“ guidance. Consider early use of: Emergency blood Massive Transfusion Policy Tranexamic acid 1g over 10 mins. - The maintenance dose, 1g over 8hrs (given within 3 hours of Trauma) should be given on return from CT in order to minimise infusions needed in the CT scanner, and to focus the team on preparation for the CT scanner. Combat Application Tourniquet – use and management. Consider eFAST – if this would enhance and not delay ongoing patient care.

Arrival On arrival of the patient into resus the TTL will make a brief assessment of the patient (a ‘5 second round’) to ensure no immediate interventions are required The pre-hospital team will move to the patient right side of the stretcher and liaise with the TTL to move the patient from the ambulance stretcher to the hospital trolley with a trauma mattress. The ambulance stretcher should then be removed from the cubicle. Patients arriving by air will be wheeled in directly on a hospital trolley and no movement of the patient is required. The pre-hospital team will then give a verbal handover of the patient to the Trauma Team. This is an important handover of information; the whole hospital team should give this their full attention. No one should touch the patient during this process whilst the pre-hospital team continue to monitor the patient. This process should not be interrupted, unless critical, with questions held until the end, to prevent the loss of vital information. Patient Transfer Team members may be required to remain with the patient during transfer to CT or Theatre. Whilst sliding the patient up or down into the head cradle, the TTL should hold the trauma mattress fixed in position whilst the trauma team slide the patient. Trauma team members must remain with the patient until appropriate disposal is achieved. If any team member needs to leave the trauma team environment – this must be discussed and agreed by the TTL. Antibiotics, urinary catheter, arterial lines, tetanus, pregnancy test need early consideration but can be delayed if transfer to theatre for emergency surgery is required. Resuscitation is managed as a dynamic process which is not dependent on geographical location. Handover: The TTL determines the speciality to lead ongoing inpatient care. Inform Blood Bank: When patient transferred and likely ongoing blood product requirements. Speak to Relatives Documentation: Review completed Trauma case note documentation Complete Hot Debrief form Debrief team

Start of Shift Collect speciality trauma bleep and receive handover + relevant speciality situational report. Trauma Team Activation ‣ Inform respective Speciality team members / Consultant / Theatres of incoming trauma – thereby allowing for proactive planning of personnel, resources and theatre space. ‣ Attend Resus area of the ED as soon as possible on receipt of trauma call. The decision to activate the trauma team is based on the expectation that the alerted team members will be present to receive the patient. There is no requirement for team members to ring the ED to discuss the case prior to the patient’s arrival. On arrival to the Emergency Department: ‣ Identify yourself to the Trauma Team Leader. ‣ Give name, specialty and grade to the scribe ‣ Fill in your identification sticker and place in a visible place ‣ Confirm expected role ‣ Ensure adequate personnel protective equipment ‣ On arrival of trauma team, all team members should be on the patient’s left of the ED trolley, except the primary survey doctor, airway nurse, and anaesthetist. The paramedics will then be on the patient’s right. Remain with the patient until appropriate disposal is achieved If you need to leave the Trauma Team environment – this must be discussed and be agreed by the Trauma Team Leader.

Key Roles ‣ Catastrophic haemorrhage control ‣ Cervical spine and pelvic stabilisation ‣ Venous access ‣ Perform secondary survey ‣ Determine imaging requirements (additional to trauma CT) Patient Management ‣ Direct pressure haemorrhage control as required, in extreme conditions for extremity bleeds – consider tourniquet use. ‣ Ensure c-spine protection adequate ‣ Ensure pelvic splint in situ, correct size and placement ‣ Ensure legs aligned with internal rotation – bandage ankles to maintain position Venous Access ‣ Venous access – shared role – as directed by TTL ‣ Confirm patency of IV access ‣ Unless the patient has two patent IV access sites - Gain IV/IO access with 20mls blood samples for:- FBC, U&E’s, LFT’s, lipase, clotting screen, cross-match, venous blood gas and blood glucose ‣ If possible, free cannula to be placed in the back of the left hand for the IV contrast. ‣ If the patient has two patent i.v. access sites then gain 20mls blood for samples from a femoral arterial puncture ‣ Ensure samples are labelled correctly and dispatched to the appropriate departments. Neurological Assessment ‣ Perform baseline peripheral neurological examination, prior to anaesthesia if planned or just prior to logroll as directed by TTL ‣ Ensure c-spine protection in situ and placement correct if directed by TTL Orthopaedic Assessment ‣ Identify & splint long bone fractures ‣ Contribute to case discussion with the TTL, particularly where limb or lifesaving interventions are required

Once the primary survey and immediate lifesaving interventions have been achieved, the orthopaedic consultant must be informed of the likely case progression. This may require the attendance of the consultant to ED resus or to theatre as appropriate. Secondary Survey ‣ Carry out secondary survey, when deemed appropriate and verbally report findings to TTL and scribe ‣ Document all wounds, grazes and degloving directly into the trauma booklet ‣ Evaluate each joint and long-bone for dislocation / stability / fracture ‣ Neurovascular examination of all limbs ‣ Record presence or absence of peripheral pulses ‣ Identify peripheral injuries that need to be included in trauma CT scan ‣ Splint fractures as needed ‣ Repeat neurovascular examination after splintage Determine additional imaging requirements Any additional imaging requirements in addition to a CT Trauma series should be discussed (review “Imaging in Trauma” Guidance). Requesting of departmental films can impede the rapid progress of patients to definitive or staging care – and must be agreed amongst team members to ensure co-ordinated care. Patients who have anterior pelvic injuries may require a retrograde-urethrogram prior to insertion of urinary catheters – this is to be undertaken by the orthopaedic registrar. Discuss orthopaedic assessment / plan / needs / priorities with TTL. Case discussion should also consider the need for vascular or plastic surgery specialty attendance, dependent on injury patterns. Liaise with theatres, anaesthetic colleagues, bed manager and consultant for patients needing theatre and/or admission. Assist with sending/ordering tests, liaising with specialists or performing procedures as training and ability allows e.g. chest drains, urinary catheter. Post Trauma Call ‣ Document all actions and findings with a clear plan in patient notes. ‣ Remain with the patient until appropriate disposal is achieved ‣ If you need to leave the Trauma Team environment – this must be discussed and be agreed by the Trauma Team Leader.

Key Roles ‣ Assess Breathing and Circulation – On occasion Primary Survey Breathing and Circulation assessment may be performed by a senior Emergency Medicine Doctor at the discretion of the TTL ‣ Perform logroll examination ‣ Determine need for immediate surgical intervention in theatres Breathing ‣ Assess air entry, chest expansion, percussion and tracheal position to allow identification of significant chest pathology. ‣ Report findings to TTL, discuss, agree and institute appropriate interventions. Circulation ‣ Venous access – shared role – as directed by TTL ‣ Confirm patency of IV access ‣ Unless the patient has two patent IV access sites - Gain IV/IO access with 20mls blood samples for:- FBC, UE’s, LFT’s, lipase, clotting screen, cross-match, venous blood gas and blood glucose. If possible, free cannula to be placed in the back of the left hand for the IV contrast. ‣ If the patient has two patent IV access sites then gain 20mls blood for samples from a femoral arterial puncture ‣ Ensure samples are labelled correctly and dispatched to the appropriate departments. ‣ Complete abdominal examination ‣ Assess pelvis through visual examination and light palpation of bony prominences – work with orthopaedic registrar to ensure correct pelvic splintage ‣ Assess long bones as source of haemorrhage Perform examination on logroll – ensure full exposure. Assess for occipital head trauma, thoracic/ lumbar spinal injury, examine posterior chest including auscultation, palpate flanks, perform rectal examination and assess posterior aspect of limbs. Logroll may be delayed until after CT and indeed be part of secondary or even tertiary surveys when patients are expedited to surgical/interventional radiological management. Contribute to case discussion with the TTL. Discuss surgical assessment/plan/needs/ priorities particularly: decision on transfer to CT or Theatre - communication with theatres role is shared with ITU. Case discussion should also consider the need for vascular or plastic surgery speciality attendance, dependent on injury patterns. Once the primary survey and immediate lifesaving interventions have been achieved, the surgical consultant must be informed of the likely case progression if patient has initial SBP <90, has complex multisystem injury, or is likely to need early surgery. This may require the attendance of the consultant to ED Resus or to theatre as appropriate. Stay with the patient in Resus/CT until stood down by the TTL. Liaise with theatres, anaesthetic colleagues, bed manager and consultant for patients needing theatre and/ or admission. Assist with sending/ordering tests, liaising with specialists or performing procedures as training and ability allows e.g. chest drains, urinary catheter. Post Trauma Call ‣ Document all actions and findings with a clear plan in patient notes. ‣ Remain with the patient until appropriate disposal is achieved ‣ If you need to leave the TTL environment – this must be discussed and be agreed by the Trauma Team Leader.

Key Roles ‣ Ensure patient oxygenated and ventilated with no airway obstruction. ‣ Intubate when appropriate in discussion with the TTL – ensuring baseline neurological examination performed beforehand. ‣ Control patient logroll ‣ Ensure safe patient transfer Airway Intubated patients ‣ Take physical handover of ETT or LMA from pre-hospital team. Ensure end tidal capnography confirms placement. ‣ Assess effectiveness of BMV/ Mapleson C ventilation in conjunction with surgical registrar’s assessment of Breathing ‣ Attach to ventilator as soon as feasible – with confirmation of effective bilateral ventilation. Non-Intubated patients – requiring intubation ‣ Intubate when appropriate in discussion with the TTL – ensuring baseline neurological examination performed beforehand, orthopaedic registrar will assess peripheral limb response, anaesthetist to assess pupil response and formal GCS. ‣ Perform co-ordinated RSI with Nurse 1. ‣ Ensure end tidal capnography confirms placement. ‣ Assess effectiveness of BMV/ Mapleson C ventilation in conjunction with surgical registrar’s assessment of Breathing ‣ Attach to ventilator as soon feasible – with confirmation of effective bilateral ventilation. Non-Intubated patients ‣ Communicate airway patency and issues to TTL / scribe. ‣ Assess respiratory rate and inform TTL / scribe. ‣ It is usually appropriate for the anaesthetist to talk to the patient and provide ongoing assessment of GCS and pupil size. ‣ Reassure patient on arrival, explain what is happening, take AMPLE history and inform TTL/scribe ‣ Provide enhanced analgesia and sedation for patients that require procedures such as fracture/joint reduction/splintage and intercostal drain insertion

AMPLE History Allergies Medications Past medical history Last meal Everything else relevant Exposure Once primary survey completed and when directed by the TTL, the anaesthetist will control the log roll Consider need for endogastric tube (nasal or oral). Arterial lines may be indicated, to avoid delay to CT this can usually be done after CT or in the operating theatre. It should not delay either. Contribute to case discussion with the TTL. Case discussion should also address ongoing fluid management, blood products and inotropic support. Discuss massive transfusion protocol use in the ED and manage its implementation once in theatre, informing blood transfusion of any changes to contact name and telephone number. Once the primary survey and immediate lifesaving interventions have been achieved, the ITU Consultant must be informed of the likely case progression. This may require the attendance of the consultant to ED resus or to theatre as appropriate. Communicate any requirements with theatres - role shared with surgical registrar. Liaise with additional anaesthetist as appropriate if care to be handed over for theatre etc. Assist with sending/ordering tests, liaising with specialists or performing procedures as training and ability allows e.g. chest drains, urinary catheter. Post Trauma Call ‣ Document all actions and findings with a clear plan in patient notes. ‣ Remain with the patient until appropriate disposal is achieved ‣ If you need to leave the Trauma Team environment – this must be discussed and be agreed by the Trauma Team Leader.

Key Roles ‣ Assist 3rd on Anaesthetist with RSI/intubation and line placement as appropriate ‣ Liaise with TTL to ensure prompt access to ICU beds ‣ Liaise with TTL and ICU Consultant when additional resuscitative support is required on arrival Prior to Patient Arrival Speak with TTL prior to arrival of the patient(s). The ICU Consultant must be informed of the likely case progression. This may require the attendance of the consultant to ED resus or to theatre as appropriate. The TTL may request an ICU Consultant to attend for the initial resuscitation. Patient Arrival Assist with interventions (such as RSI and lines) as training and experience dictates. Arterial lines may be indicated, to avoid delay to CT this can usually be done after CT or in the operating theatre. It should not delay either. Contribute to case discussion with the TTL. Case discussion should also address ongoing fluid management, blood products and inotropic support. Make ICU nursing staff of the need for an ICU bed if required directly from ED or following theatre interventions. Post Trauma Call ‣ Document all actions and findings with a clear plan in patient notes. ‣ Remain with the patient until appropriate disposal is achieved ‣ If you need to leave the Trauma Team environment – this must be discussed and be agreed by the Trauma Team Leader.

Liaise with Trauma Team Lead, Senior ED Nurse and other Trauma Team Nurse. Review resus bays and ensure resus checklists are completed and signed. Highlight and address any deficiencies. Prior to Patient Arrival Responsible for supporting Trauma Team Leader. Prepare for the trauma call with level one infuser run through when indicated, warmed IV fluids run through, chest drain sets out if suggested, scoop stretcher and pelvic binder to hand. Ensure equipment for gaining large bore IV access and taking bloods is available. Ensure availability of emergency blood. Co-ordinate porters / transfer equipment – porters will need to meet patient’s transferred in by air at the helipad Patient Arrival ‣ Ensure clock started when patient arrives in resus bay ‣ Assist in transfer to the resus trolley ‣ Position yourself to the patients left side ‣ Have scissors ready, remove enough clothing initially to attach monitoring, ‣ Clearly state first observations to TTL & scribe as soon as available. ‣ Then continue to remove all clothing including underwear and store securely. ‣ Check temperature ‣ Cover with Bair Hugger / blankets ‣ Help with getting IV access and sending bloods off if required, set up intraosseus kit (ez-IO) if no/difficult IV access. Attach patient to level one infuser if required. ‣ Assist with log roll ‣ Draw up drugs / administer as prescribed ‣ Prepare for transfer to CT ASAP (within 10 minutes ideally) and/or theatre ‣ Help with procedures as identified e.g. catheter, chest drain, arterial line, dressings, and splints of open fractures / significant wounds. ‣ Ensure patient kept warm. Post Trauma Call Ensure you have documented all your interactions in the notes Ensure you have signed for any drugs Only leave the patient after liaising with the Trauma Team Leader

Liaise with Trauma Team Lead, Senior ED Nurse and other Trauma Team Nurse. Review resus bays and ensure resus checklists are completed and signed. Highlight and address any deficiencies. Prior to Patient Arrival ‣ Responsible for assisting with the initial assessment and management of airway supporting anaesthetist. ‣ Obtain an anaesthetic grab bag from the resus controlled drugs cupboard ‣ Assist in preparing any drugs requested by anaesthetist/TTL. ‣ Check all appropriate airway equipment is available and working ‣ Check suction available and working Patient Arrival ‣ Position yourself to patient’s right side ‣ Assist in transfer to resus trolley ‣ Reassure and establish a rapport with patient ‣ Assist anaesthetist with airway patency and ventilation passing adjuncts as necessary ‣ Prepare any drugs needed by anaesthetist (check drugs with them or Nurse 2). Assist during log roll ‣ Prepare arterial line equipment if requested Post Trauma Call ‣ Ensure you have documented any of your interactions ‣ Ensure you have signed for any drugs ‣ Only leave patient after liaising with the Trauma Team Leader

Key Roles ‣ Liaise with Theatres, TTL and surgical teams to ensure ready availability of operating space ‣ Provide additional skilled support if asked to do so – e.g. management of the Rapid Infuser alongside ED Nursing Team

A complex job but vital. Ensure you are being given the information you require and inform the TTL if you are not. Prior to Patient Arrival Ensure Receptionist is on-hand for rapid patient registration ‣ Ensure paperwork is available for documentation ‣ Ensure bags/documentation available for patient property ‣ Ensure team sign into Trauma Booklet on arrival ‣ Document team member’s presence in the Trauma Booklet: including speciality, grade e.g. ST3 and supervising consultant. ‣ Ensure role labels available – encourage members to place labels visibly in center of chest. Patient Arrival Ensure clock has been started when patient arrives in the Resus Bay. Ensure all patient details correct and NOK information is documented. Ensure patient wrist labels are secured on the patient. List and store safely any patient belongings Responsible for documentation of observations, events and interventions ‣ Document all pre-hospital drugs and fluids – times and amounts. ‣ Document initial vital signs and then every 5 mins in unstable patient and every 15 mins otherwise. This role continues into CT and until discharged from ED. ‣ Maintain a chronological record of all events e.g. time of venflon, CXR, FAST, move to CT etc. Inform the team leader if key observations have not been taken e.g. Temp or GCS. Inform the team leader every 15 mins that pass, the aim is to be in CT within 15 mins, when appropriate ask and document reasons for any delays. Keep a log of the running total of blood products transfused – this role may be done by a specified nurse member responsible for the level one infuser. In a massive transfusion after every 4-5 units prompt the TTL of need for adjuncts (such as calcium or insulin / dextrose). Post Trauma Call ‣ Ensure all documentation is complete ‣ Print out pre-hospital ePCR ‣ Liaise with police if any property handed over for evidence ‣ Ensure all drugs/fluids signed for by appropriate person ‣ Only leave the patient after liaising with the TTL

Key Roles ‣ Present to TTL, discuss plan for immediate CT imaging based on pre-hospital clinical information ‣ Work with trauma team to ensure CT performed within 15 minutes of patient arrival ‣ Ensure Radiologist available to review images as the patient is in the scanner

Key Roles ‣ Obtain plain film x-rays as required during trauma call ‣ Place cassettes under the trolley to speed up initial x-rays ‣ Liaise with TTL or nurse in charge if team members are not wearing lead. Liaise with TTL if team members are obstructing your chance to x-ray to prioritise actions.

Key Roles ‣ Liaise with CT radiographer to clear the CT Scanner and communicate with resus when scanner is likely to be available. ‣ Attend the trauma call whenever possible as your expertise will be valuable in reviewing x-rays, eFAST scans and early recognition of interventional radiology requirements and planning of imaging (CT vs US). ‣ Most trauma patients will need early CT, national guidelines are to complete the CT and have the initial report within 30 mins of arrival in ED. ‣ A standardised reporting proforma is used to ensure rapid reporting.

NEED TO ADD IMAGE

The Emergency Department drug bag should be stored in the locked controlled drug cupboard in resus. Contents of the ED Major Trauma Drug Bag:

The ED drug bag contents may change over time, but should contain all key drugs to safely perform emergency anaesthesia for all types of major trauma patients. The Emergency Department have a separate SOP covering the management of controlled drugs within the drug bag in the Emergency Department. Clinicians should familiarise themselves with this.

The Intensive Care Unit has two emergency drug bags in the Pod D Controlled Drug fridge. One of these bags should be taken to any in-hospital trauma. Contents of the ICU Emergency Drug Bag:

The Intensive Care Unit has a separate SOP covering the management of controlled drugs within the ICU Emergency Drug Bag. Clinicians working on the Intensive Care Unit should familiarise themselves with this.

Communication with Relatives Effective and timely communication with relatives is crucial. Key points include: Conversations with family members should take place in a room offering privacy and ‣ space with refreshment facilities and a telephone available The most experienced clinician involved with the patient should convey information ‣ to relatives to avoid conflicting information and mixed messages being given The doctor should be sensitive of religious, cultural or other needs of the family ‣ A good starting point is to find out what the family already know about the patient’s ‣ current condition. Bad news should be communicated in a timely and sensitive way, avoiding ‣ euphemisms and jargon. Listening is as important as talking when breaking bad news. ‣ A nurse should accompany the doctor when breaking bad news in order to support ‣ the family Following death, relatives should be allowed to ‘say goodbye’ ‣ Offer support from appropriate faith or religious leaders (available via switchboard). ‣ This may provide support to relatives whilst the patient is in theatre or following death It is good practice to provide follow up for the relatives of a deceased patient ‣ A letter of condolence to the family after the event is appreciated ‣ Departments should consider giving the name and telephone number of a ‣ Consultant that relatives can contact at a later date. Providing the family with an appointment a few weeks after the death to discuss the ‣ events has been shown to help families with their grieving process Staff Support After every death or incident staff should be encouraged to talk together about the ‣ event. In many cases a formal debrief can be valuable Further support should be available to staff through their supervisor or from occupational health

Where withdrawal of life sustaining treatment is being considered the following steps should be taken Communication with relatives Information should be provided in a timely and open manner by the most ‣ experienced clinician familiar with the patient including details of their relatives condition, possible outcomes, assurances their relative is not experiencing pain or distress and when appropriate, an indication when death is imminent Regular updates of a patient’s condition should be provided. Where indicated, ‣ interpreters should be used Communication between staff members is essential to prevent conflicting information ‣ being provided A named link nurse to support relatives and act as an advocate for the relative(s) is ‣ essential NBT supports the principle of witnessed resuscitation; this should be offered where ‣ appropriate Offer relatives the opportunity to spend time with the patient before transfer to ITU or ‣ theatre, even if this is only for a brief period. Children should not be excluded as they may imagine a situation far worse than the reality General Points Any patient where withdrawal of life sustaining therapy is being considered should be ‣ discussed with the on-call ICU Consultant so that an appropriate management plan and location can be agreed. All patients with a perceived devastating brain injury where no neurosurgical ‣ intervention is planned should be discussed with the on- call ICU Consultant regarding admission to ICU for a period of neuro-prognostication. This should be explained to relatives ‣ No discussion about organ donation should take place in the ED when an ICU admission is planned ‣ When withdrawal of life sustaining treatment is planned to take place in ED, a SNOD must be contacted by the Trauma Team Leader prior to discussing organ donation with the patient’s relatives. Every reasonable effort must then be made to wait for the SNOD to attend before initiating a discussion about organ donation with a patient’s relatives If an approach for organ donation is undertaken in the ED a planned, collaborative ‣ approach involving the senior doctor, SNOD, and named linked nurse should be undertaken.

Any discussion regarding organ donation must be separated from information ‣ regarding prognosis. This ‘de-coupling’ of ‘breaking bad news’ and an approach regarding organ donation allows relatives time to begin to understand the position their relative is in. Organ donation must not be raised until it is clear that relatives have understood and accepted the clinical situation. At NBT, SNODs are located in the ICU administration office during office hours and ‣ via 03000 20 30 40 at all other times. A green folder containing information relating to organ and tissue donation can be found in the office behind ‘see and treat’ in ED. Information is also available on the intranet or from the SNOD Staff Support After every death or incident staff should be encouraged to talk together about the ‣ event. In many cases a formal debrief can be valuable ‣ Further support should be available to staff through their supervisor or from occupational health

Verification of death must be completed as per NBT policy and documented on NBT ‣ verification of death paperwork. Where required, a death must be reported to the coroner as soon as possible. ‣ Nursing staff must complete a deceased patient record which ensures GP’s are ‣ notified and information collated for follow-up and audit In the event of a paediatric trauma/death, ‘Form A’ - notification of child death, must ‣ be completed. The consultant community paediatrician (contacted via BRI switchboard - 76100) and Ann Fry (named nurse for child protection- 0117 323 2363) must be contacted Tissue Donation must be considered in all patients after death. The completed ‣ referral form should be emailed to the National Referral Centre at National.ReferralCentre@nhsbt.nhs.uk Relatives should be given the ‘When Someone Dies’ leaflet. This contains practical ‣ guidance and details of support services. A member of the bereavement team will contact a deceased’s family for follow-up and support ‣ Any further information or guidance required please speak to the ED nursing team who are experienced and trained in ED bereavement care.

ADD DIAGRAM HERE

The Severn Trauma Network serves an adult population of around 2.3 million. The South West has a greater proportion of inhabitants of pensionable age than any other English region (19.6%) and this is reflected in network data. The average age of major trauma patients treated in the network is 65. The majority of major trauma patients across the network are treated as the result of a fall from less than 2m. Road traffic collisions are the second most common cause of injury, followed by falls more than 2m.

Following the introduction of Regional Major Trauma Networks, Major Trauma Centres are required to have an automatic acceptance policy for patients requiring treatment for major trauma injuries. The purpose of this policy is to provide direction and guidance for actions from key individuals and organisations within the Severn Major Trauma Network to improve the patient pathway and quality of care. To do this it will: ‣ Ensure the automatic acceptance of major trauma patients after consultant to Trauma Team Leader (TTL) referral within the Severn Trauma Network from Trauma Units to the Major Trauma Centre ‣ Ensure that all relevant parties are aware of their specific roles and responsibility, and prevent the acceptance and transfer of patients being delayed ‣ Describe the procedure where capacity to accept severely injured patients is exceeded.

This policy will relate to patients from Trauma Units and Local Emergency Hospitals within the Severn Major Trauma Network area following a major trauma injury. This policy applies to referring trusts hospitals, ambulance trusts and local air ambulances. It is the responsibility of North Bristol NHS Trust staff to ensure that that this policy is followed from first contact by an outside agency. The policy will be implemented by personnel in the Emergency Department, Intensive Care, High Dependency Units and General Wards. The final responsibility for the implementation of this policy lies with the on call Major Trauma Consultant (TTL) who accepts the patient. The trauma team leader can be contacted on 07703 886400. Departure from the policy would have to be justified to the Executive On call manager with clear and compelling reasons. Any departure from the policy must be documented in the patient notes and flagged through the major trauma governance process – MTGovernance@nbt.nhs.uk

This policy applies 7 days a week, 24 hours a day All relevant clinical information is to be given to the receiving Trust The Retrieve Adult Critical Care Transfer Service provides triage and coordination of all adult critical care transfer referrals 24/7 and should be contacted whenever a critical care transfer is required. All adult critical care transfer referrals should be made to Retrieve via their single point of contact telephone number (0300 030 2222) In certain circumstances (at night and when the Retrieve team are committed elsewhere), the referring Trauma Unit will be required to undertake the transfer, providing appropriately trained and experienced clinical escorts and using a 999 ambulance (accessed via Retrieve). The transfer of the patient is to be organised by the referring hospital, providing necessary escort arrangements, together with all necessary documentation including the Severn Major Trauma Network trauma patient record. This policy should be read in conjunction with: ‣ The Severn Major Trauma Network repatriation policy ‣ SWASFT Major Trauma Triage Tool ‣ Inter-Hospital Transfer of Critically Ill Adult Major Trauma Patients ‣ Major Incident Policy

In the case of an emergency transfer the referring hospital must contact the on-duty Major Trauma Consultant (TTL - 07703 886400) with details of the patient. The referring hospital must also inform the Ambulance Service Coordination desk of the transfer and details of the patient. Retrieve should be contacted for any critical care transfers. The transfer procedure must be carried out at TTL level Full patient details including name of referring TTL and time of referral to be recorded in the Major Trauma booklet 15 Patient notes including their Major Trauma booklet should be transferred to the receiving hospital with the patient. On arrival, the patient is met by the major trauma team and trauma call procedures initiated

The Severn Major Trauma Centre has a duty of care to the population covered by the Severn Major Trauma Network and must accept all severely injured patients in a timely manner. Timely is defined as according to the urgency of transfer as defined by the Trauma Team Leader only. Where there are problems with capacity in specific areas of NBT (such as critical care) to accept patients from the Severn Major Trauma Network, it is the responsibility of the affected unit/department to inform the TTL in a timely manner and to work together to resolve the situation expediently. Capacity constraints cannot be used over clinical priority to turn-down or delay patients. In the unlikely event that a patient at a Severn Trauma Unit required a Major Trauma Centre Bed and the patient cannot be accepted at NBT because of capacity (such as during a major incident) it is the responsibility of the NBT TTL to ensure that an alternative bed can be sourced in another Major Trauma Centre (in conjunction with the Ambulance Service Coordination centre). The decision of whether a patient requires immediate major trauma centre care (and therefore must be accepted) is made by the TTL. If no other Major Trauma Centre within clinically acceptable transfer time can accept the patient then North Bristol NHS Trust must accept the patien

NBT Trauma Team Leader (Consultant): 07703 886 400 SWASFT Ambulance Co-ordination Desk: 0845 1206342 Retrieve: 0300 030 2222

The Trust is notified of a major incident by the Ambulance Service via an automated system to the Emergency Department. Information regarding the incident is communicated using the METHANE mnemonic which provides key information needed to inform the Trust’s response: 1. Major Incident Standby / Declared 2. Exact Location 3. Type of Incident 4. Hazards—both present and potential 5. Access and egress to the incident 6. Number of casualties and a breakdown of types i. Priority 1 (P1), life threatening injuries, resus ii. Priority 2 (P2), urgent, non life threatening, majors iii. Priority 3 (P3), delayed, minors iv. Number of children, burns etc 7. Emergency Services already at scene or involved in responding to the incident On receipt of the Major Incident Notification, the Emergency Department documents the METHANE and initiates the appropriate response as outlined in the Major Incident Plan. 17 INITIAL MASS CA

Principles Influencing Triage: ‣ Number and type of casualties ‣ Location of the incident within the network ‣ Neurosurgery only at NBT, cardiothoracic services at UHBW (one thoracic surgeon will receive patients at NBT). Specialised children’s services at BCH.

Severn Casualty Capability Chart: Pre-determined capacity for the first 2 hours

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Total capacity for Severn (200). Ideally: ‣ Priority 1s to MTC ‣ Priority 2s to trauma units (but TUs may also have to take priority 1s) ‣ Priority 3s to TU’s, LEH’s and other appropriate facilitates. These figures relate to the first 2 hours and should be viewed in the context of incidents producing mass casualties: within small incidents the figures for each unit will be lower.

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All receiving hospitals should ensure they enact plans to enable them to free up 20% of their total bed base, 10% of which should be in the first six hours, and a further 10% within 12 hours of the incident declaration, allowing patients from the incident scene to be rapidly placed and ensure patient flow. In addition to this, hospitals with level 3 Intensive Care capability should prepare to surge to double their normal level 3 ventilated bed capacity and maintain this for a minimum period of 96 hours. Trauma Units should be prepared to manage patients who they would usually treat and transfer for extended periods, along with preparing to receive additional repatriations from the MTC. During a mass casualty incident, it may be necessary for receiving hospitals to expand their emergency capacity into space not usually occupied by the emergency pathway. This will require the activation of business continuity measures. Organisations will need to consider activation of their lockdown arrangements to support site security and the need to protect access to health care facilities to those in need of treatment. In the event of being in a scene cordon the hospital may be asked to act as a temporary rest centre or reception centre.

Trusts should be prepared to provide the information required on the NHS England National Incident Situation Report Template, or specific incident template issued during the incident to the appropriate time scales.

National arrangements for the identification of victims are likely to be invoked. These may include the activation of National Emergency Mortuary Arrangements (NEMA) or the designation of a Designated Disaster Mortuary (DDM) which may be on NHS premises but operated by the local authority. It may be the case that the mortuary space in NHS hospitals has to be managed carefully, and coordinated with the appropriate HM Coroner’s Office, HM Police and Local Authority to maintain capacity. This will be important where deceased are to be held for a period of time, and there will be delays in taking hospital mortuary bodies to the designated disaster mortuaries

NHS England will form a Clinical Cell with the Duty Clinical Director along with representatives of the NHS England EPRR Clinical Reference Group, with additional specialist representation as required. This cell will act to ensure that the NHS England Incident Management Team (National) has the appropriate access to clinical advice to inform the response. NHS England may make use of Medical Directors from Regional Offices and DCO teams to support the clinical cell in a protracted incident or where they have specialist subject advice required of the response. In addition to this, NHS England may contact individual experts to offer advice based on available known staff in organisations. Clinical Impact Assessment Call Within the first twenty-four hours of an incident, the Lead National Medical Director will establish a clinical call with responding centres to ascertain the likely impact to services and patient management across all services. An agenda for this is provided in Annex 6: Clinical Impact Assessment Call Agenda Where possible this call will be held on the secure teleconferencing facilities accessible through the NHS England EPRR Duty Officer (NHS05). Ethical Decisions It may become necessary to enact decisions relating to the ceilings of care during a mass casualty incident to ensure the greatest number of survivors possible. This may include the decision by the Clinical Cell to invoke the expectant triage category at the scene. This decision will be time limited, continually under review and only used at a time when NHS resources are overwhelmed Patient Placement The Clinical Cell will advise on the placement of patients who need to be transferred out of the incident response areas to ensure they receive the most appropriate definitive care. Clinical Debrief The Clinical Cell will establish a clinical debrief for the incident, the hot debrief will be held within two weeks of the incident, with a structured clinical debrief within one month. Recovery Cell Nationally a Recovery Cell will be established to coordinate with the response and ensure work is undertaken to manage the recovery of NHS England and the NHS in England. This group will look at the recovery support required and ensure liaison between recovery groups at all levels of the organisation and out to those groups established as part of SCG response.

Decision making for return to normal working ultimately rests with Incident Director (National). This may be delegated as the incident response evolves and recovery commences to regional leads; however, the option to refer to the designated national lead should remain in the case of local/regional dispute or unacceptable variation in recovery actions occurs. ‣ Financial implications must be transparent, and principles applied consistently across the system by providers and commissioners ‣ Recovery should be led by a senior Regional Recovery Lead and coordinated nationally across the health economy to ensure continued application of mutual aid principles, effective use of resources and to facilitate repatriations ‣ National, regional and local recovery leads should liaise at an early stage and throughout the process with ODNs. The ODNs will provide local intelligence and advise on actions to be taken at system level (local/regional/national) ‣ Return to organisational business as usual may take considerably longer than normal. ‣ Trauma cases may require multiple and prolonged returns to surgery and/or stays in critical care. ‣ Specialist services may need to be commissioned or expanded to deal with additional demand on a medium to long term basis ‣ Patients may need to be repatriated into their own health economy a long way from the incident location and may require medium to long term care and rehabilitation. Commissioners will need to agree the provision of additional resources. ‣ National support will be required to recover costs from overseas patients and national arrangements should be set out in advance. Costs may be for short, medium or long term care and treatment and could include; emergency and/or specialist treatment and care, rehabilitation services and repatriation. ‣ Discussions around the reduction, alteration, suspension or cancellation of services by organisations supporting the incident that impact on their national standards should be conducted between regulators at a national level. ‣ Proactive capture of points to inform learning from response and facilitate recovery should be achieved.

All NHS organisations involved in the response will be expected to undertake a debrief as per the requirements of the NHS England EPRR Framework and Core Standards. Trusts may be invited to multiple debriefs by many agencies and should attend these where possible.

Psychosocial support should be offered to patients and staff as needed they should also be made aware of those symptoms that are normal during the initial period following a traumatic event, An NHS England post incident leaflet is available ‘Access to post incident mental health services leaflet’. NEED HYPERLINK TO THE LEAFLET

Risk factors and likely injury types National planning assumptions state the likely split across triage categories will be 25% Priority 1 (casualties needing immediate intervention), 25% Priority 2 (casualties needing early treatment but delay acceptable), 50% Priority 3 (casualties needing treatment but a longer delay is acceptable). The cause of the incident is likely to dictate the type of injury from a Mass Casualty event however there is likely to be: ‣ Severe Blunt Force or Ballistic Trauma (especially in firearms and bomb related incidents) across specialties. ‣ Burns ‣ Acoustic Injuries (where blasts have occurred) Environmental Local conditions can impact on the ease to get to medical facilities and the ease of access to patients requiring a greater response from the hospital. Weather conditions can impact on the number of casualties in an incident and the type of treatment and staff required to respond, extremes of temperature can increase the risk of shock, and bring about exposure related illness. Water Supplies Water supplies could be the cause of a mass casualty incident or impacted upon by an incident. The Trust has in place utility disruption plans to allow services to continue in the event of a disruption or contamination to supplies. Advice should be sought from Public Health England during any incident of this nature. Lack of water supplies may require a change in the way patients are cared for and effect immediate treatment. VIP Visits It is likely during and/or following a mass casualty incident there will be significant interest from VIPs to visit hospitals and those affected. This may need to be coordinated nationally to ensure that appropriate arrangements are in place. Visits from VIPs can require extensive resourcing and organisations need to carefully consider these against the need to deliver ongoing patient care.

The repatriation of major trauma patients to their local hospitals has the potential to be challenging for the patient, carers and organisations involved. Unnecessary delays are unhelpful in a number of ways: ‣ They can impede care packages for patients ‣ They can be inconvenient or distressing for both patients and relatives ‣ They are a source of frustration in relationships between hospitals ‣ They can prevent acutely ill patients being admitted into designated beds ‣ Can affect patient flow and operational running of the Major Trauma Centre (MTC) The purpose of this policy is to provide direction and guidance for actions from key individuals and organisations to reduce the challenge and improve the patient pathway and quality of care for major trauma patients. It also aims to replicate the automatic acceptance principle that ensures acceptance of patients from the Trauma Units (TU) to MTC during the early phase of care. It will provide the MTC with an effective means of returning patients to their original or local Trust following their initial acute treatment and therefore ensure capacity is available in the MTC for any further patients requiring major trauma care.

The policy will be formally agreed and accepted amongst all organisations within the Severn Trauma Operational Delivery Network (ODN) and relate to those patients admitted to North Bristol NHS Trust (MTC) following major trauma. This policy applies only to TARN inclusion criteria major trauma patients. For operational purposes, major trauma patients are those that have been received following triage according to the Major Trauma Triage Tool (Page 45). It does not apply to patients other than those deemed to have major trauma injuries at time of transfer.

The policy will ensure that all patients are repatriated to their local health care provider when they are medically fit or have completed specific treatment at the MTC. It will ensure that all relevant parties are aware of their specific roles and responsibilities and prevents delay to patient transfer. It will provide clear guidance for action when patient pathways become blocked.

The process outlined in this policy applies twenty-four hours, seven days a week to all organisations within the Severn Trauma Network. ‣ The MTC is committed to automatically accepting major trauma patient transfers into the centre. As such to maintain flow it is critical that there is a robust and reliable process for repatriation to TU. A principle of automatic acceptance for repatriations needs to be approved by TU. ‣ MTC clinical teams will make contact with the receiving Trust clinical team and agree the transfer and acceptance of care using the Repatriation Notification Form (Page 26). ‣ The MTC and other hospitals should maintain communication throughout the patient’s stay at MTC as appropriate. ‣ The MTC will provide as much notice as is reasonably possible of repatriation and endeavour that this is no less than 48 hours before repatriation is required. ‣ All relevant clinical and social information is to be provided to the receiving Trust upon referral. ‣ An escalation policy will be triggered if a bed is not allocated to a major trauma patient within 24 hours of them being ready for transfer. ‣ Transport will be organised by the MTC, providing necessary escort arrangements, together with all necessary documentation including a formal typed discharge summary to accompany the patient. ‣ If the patient has critical care needs, transport arrangements can be discussed with Retrieve – 0300 030 2222. ‣ Lack of rehabilitation facilities within the receiving organisation should not affect the repatriation of patients. 24 ‣ A patient must be accepted by a senior doctor (ST3 and above) doctor within the specialty required before the repatriation process can begin. Please note that for quadriplegic patients returning to hospitals within the Network an accepting consultant in the receiving specialty is required.

24 Hours If repatriation has not occurred within 24 hours of patient being fit for transfer, then the Operations Manager at the MTC will be informed and will communicate with the Operational Lead at the receiving Trust. Out of hours this will be the site team lead or the manager on call. 48 Hours If repatriation has not occurred within 48 hours of patient being fit for transfer, then the Deputy Director of Operations at the MTC is to be informed and communicate with their equivalent at the receiving Trust. 72 Hours If following discussion between Directors of Operations, no agreement can be reached, a time for repatriation will be established by the MTC approximately 72 hours from patient being ready for transfer and this will be confirmed with the Trauma Unit, who must identify a receiving team and ward, the patient will then be transferred.

This policy will be monitored jointly by all Trauma Unit clinical and managerial leads and the Severn Major Trauma Operational Delivery Network Board. A formal review will be undertaken annually, and amendments will be made as necessary.

Major Trauma Repatriation Notification Form

Major Trauma Centre Coordinators to Complete Top Section and Email to Receiving Trust nominated email address.

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Research Division: ASCR

General overview of study: A multi-centre randomised controlled trial of both the effectiveness and cost-effectiveness of the treatment of hypertrophic burn scars with Pulsed Dye Laser (PDL) and standard care compared to standard care alone.

Funded by: NIHR

Principal Investigator: Jonathan Pleat

Patient Group: Patients with ≥1% TBSA burn wound grafted or conservatively managed

For additional information: Please contact MTTraining@nbt.nhs.uk

Research Division: Emergency Department

General overview of study: Conservative Management in Traumatic Pneumothoraces in the Emergency Department (CoMiTED). This is a Randomised Controlled Trial

Funded by: NIHR Health Technology Assessment Programme

Principal Investigator: Edd Carlton

Patient Group: Aged, or believed to be aged 16+ with Traumatic Pneumothoracies in whom the treating clinician(s) believed either chest drain or conservative management is a suitable treatment

For additional information: Please follow the link CoMiTED – Conservative Management in Traumatic Pneumothoraces in the Emergency Department (CoMiTED): A Randomised Controlled Trial (bristol.ac.uk)

This single day study event will provide an introduction to the following topics: Overview of Major Trauma networks, the influence of Human Factors on teamwork, ABCDE of Paediatric Major Trauma Care, Trauma skills stations &Trauma simulations. This is a chargeable course – approx. £50 per attendee.

Duration: 1 day

Target candidates: This event is aimed at nursing staff with minimal or no experience of Paediatric Major Trauma. Attendees will be working within an Emergency Department/ working in a different department who may be called to assist with a paediatric trauma.

For enquiries please contact: FacultyOfChildrensNurseEducation@UHBristol.nhs.uk

This single day study event will build on your existing knowledge and prior experience of major trauma. Topics include: Advanced Airway Skills, Neuro-assessment/Spinal Shock, Bereavement and Organ Donation, Burns, Human Factors Elements of Senior Nurse Role &Trauma Simulations. This is a chargeable course – approx. £50 per attendee.

Duration: 1 day

Target candidates: This event is aimed at nursing staff with a minimum of 2 years emergency nursing experience. Attendees will be working within an Emergency Department/working in a different department who may be called to assist with a paediatric trauma.

For enquiries please contact: FacultyOfChildrensNurseEducation@UHBristol.nhs.uk

The TILS study day encompasses lectures, workstations & Trauma moulages where all the skills learnt during the day are consolidated in simulation. The candidates are not expected to undertake skills or roles during the day that they don’t undertake in real life, the course helps standardise the care & treatment that each major trauma patient will receive regardless of day/ time of attendance.

Duration: 1 day, 6 times per year at MTC.

Target candidates: All nurses within the Emergency department will complete. New Band 5 nurses starting in the emergency department will be booked into the TILS study day within 6 months of starting their post. There will be a trial period of opening this course up to junior doctors in the Emergency department and wards. Each trauma unit should have their own TILS course implemented with resources provided by the MTC but network places can be made available to support units as required. 

For enquiries please contact: EDEducationTeam@nbt.nhs.uk

To be completed approx. 2 years after TILS. Recap on Trauma skills with new workshops and simulations.

Duration: 1 day, 6 times per year at MTC.

Target candidates: All nursing bands that have completed TILS.

For enquiries please contact: EDEducationTeam@nbt.nhs.uk

Neuro ward study day. Provides an overview of brain anatomy, seizure management, clinical skills including Glasgow Coma Scale assessment, log rolling and hard collar application. Spinal cord injury and autonomic dysreflexia. Brain haemorrhages, neuro psychology and neurogenic bowel and bladder, EVD/lumbar drain management and FVC.

Duration: 7.5 hours, run quarterly

Target candidates: Nurses from 6b, 7a, 25a, 34a, 34b

For enquiries please contact: Abigail.Lindsay@nbt.nhs.uk : Book on LEARN

Plan to develop a trauma course with an emphasis on musculoskeletal trauma, and wider areas of major trauma care including special circumstances, psychological aspects, deteriorating patients and chest drain care and management.

Duration: 7.5 hours, run bi-yearly

Target candidates: Nurses from 25a, 6b, ICU, 33a, open to other wards receiving trauma

For enquiries please contact: mttraining@nbt.nhs.uk

Adapted from the Musgrove Park hospital course. This is a comprehensive course mapped to the level 2 requirements in the NMTNG competencies. Would need to be PEER reviewed by the NMTNG once established and running.

Duration: 15 hours, run bi-yearly

Target candidates: Senior nurses and junior doctors in the Emergency Departments across the Severn Network.

For enquiries please contact: mttraining@nbt.nhs.uk

The European trauma course is an internationally recognised trauma course covering the initial assessment and management of a major trauma patient. It is certified by the European Resuscitation Council. The course is a mix of workshops and scenarios course which is reflective of the European (including UK) approach to trauma in the hospital setting. This is a chargeable course – approx. £750 per attendee.

Duration: 2 ½ days, twice per year

Target candidates: Aimed at nurses and doctors who will be involved in the initial management and assessment of a major trauma patient. Usually band 6 and above nurses, or doctors ST3 and higher.

For enquiries please contact: ResuscitationTraining@nbt.nhs.uk

This annual regional update for Severn Major Trauma Network trauma team leaders (TTL’s) is a mandatory course for TTL’s. Attendance on at least 1 day every 3 years is required to remain on the rota. It consists of a series of lectures and wet lab dissections that focuses on recent changes in trauma practice and surgical skills required for rare events. These events include (but not restricted to) resuscitative thoracotomy, lateral canthotomy, emergency amputation and surgical airways.

Duration: 1 day, once per year

Target candidates: Trauma Team Leaders and aspiring Trauma Team Leaders who will are eligible to join the consortium or emergency department trauma team leader rotas. (Substantive Consultants in post within the trauma network, who have sufficient credibility in managing major trauma patients.)

For enquiries please contact: mttraining@nbt.nhs.uk

This is a half day simulation course, aimed at those providing anaesthesia cover on the 3rd on-call rota covering major trauma calls and ED nurses. The purpose of the course is to provide an evidenced-based, standardised approach to emergency anaesthesia for major trauma. It focuses on utilising our Standard Operating Procedure for rapid sequence induction in trauma.

It aims to consolidate the experiences of trauma anaesthesia candidates have and provide exposure to the common emergencies and guidelines associated with anaesthesia for Major Trauma in the MTC.

Duration: ½ day, 3-4 times per year.

Target candidates: Those who will be delivering or assisting in the delivery of anaesthesia to major trauma patients in the emergency department. This includes senior nurses, trauma team leaders and senior trainees (ST3+) and consultants in anaesthesia and critical care. Places open to the network.

For enquiries please contact: mttraining@nbt.nhs.uk

This course is a combination of workstations, and lectures specifically related to surgical intercostal chest drains in the context of major trauma. It covers indications, complications, technique for insertion and ongoing management of the drains. The last section looks at the indications for referral and the bespoke traumatic chest injury pathway including access to specialist thoracic services.

Duration: ½ day, 3 times per year (MTC). 1 session planned at YDH.

Target candidates: Those who may be expected to insert chest drains in trauma i.e. ST3 and higher specialist trainees in orthopaedic surgery, general surgery, anaesthetics/ intensive care, and emergency medicine. Places open to the network.

For enquiries please contact: mttraining@nbt.nhs.uk

Introduction to the role of the scribe & in-depth look at the documentation required.

Duration: ½ day as required for MTC or TU’s in the Severn Major Trauma Network

Target candidates: Emergency Department Band 3’s. Places open to the network.

For enquiries please contact: EDEducationTeam@nbt.nhs.uk

We provide training to F1 and F2 doctors trust wide as part of their weekly training programme. We focus on the primary survey, the assessment of the Major Trauma patient and procedures including transfusion, splints and binders and reduction of fractures.

Duration: 1 day

Target candidates: F1 and F2 Doctors

We visit departmental induction to explain the role of the Trauma Team and the staff members within it. We also include dates for planned study days and M&M meetings. Currently attend Medicine, General Surgery, Neurosurgery and Orthopaedic induction sessions. We can tailor this training to meet the needs of your staff.

If you would like us to attend your induction, or arrange a specific teaching session, please get in touch.

Duration: 1 day

Target candidates: Junior Doctors

Adapted from the Musgrove Park hospital course. This is a comprehensive course mapped to the level 2 requirements in the NMTNG competencies. Would need to be PEER reviewed by the NMTNG once established and running.

Duration: 15 hours, run bi-yearly

Target candidates: Senior nurses and junior doctors in the Emergency Departments across the Severn Network.

For enquiries please contact: mttraining@nbt.nhs.uk

This is a simulation based course looking at technical and non-technical skills for all members of the major trauma team. The aim of the course is to create an environment in which to practice trauma team skills, promote team working and to discuss any aspects of trauma team management.

Duration: 1 day, twice per year

Target candidates: All staff who will be attending trauma calls in the emergency departments.

For enquiries please contact: mttraining@nbt.nhs.uk