1. Paediatric Major Trauma Centre Update 3 rd September 2014 Giles Haythornthwaite Paediatric Major Trauma Centre Clinical lead Giles.Haythornthwaite@UHBristol.nhs.uk

2. 20 per cent higher in-hospital mortality rate for trauma patients in England compared to the US. UNICEF “In every single industrialized country, injury has now become the leading killer of 1 to 14 year-olds - accounting for almost 40 per cent of deaths in that age group.” In 2007, NCEPOD concluded that 60 per cent of major trauma patients received a standard of care that was ‘less than good practice’. National Context.

3. But what is a Major Trauma Patient? DROWNING BRAIN or SKULL injuries ASPHYXIA FEMUR and PELVIS Fractures Internal injuries to THORAX or ABDOMEN NERVE injury SPINE Cord Injury, fracture, dislocation Open LIMB or bilateral fractures FROSTBITE MAJOR DEGLOVING INJURY

4. Major Trauma challenge Major Trauma as a disease does not respect clinical specialties or anatomical boundaries. Major Trauma patients are acutely sick with a high mortality. Treatment often is required in a time critical way.

5. The principles to improve care. Build functionally teams which work across clinical boundaries. Senior (consultant) timely decision making. Access to rapid diagnostics. Access to rapid treatment – Blood – Theatre – Supportive care (intensive care) Rehabilitation

6. Criteria for triggering major trauma call

7. Child Maltreatment Recognition. Investigation and Resuscitation run parallel. Scrutiny of medical management.

8. What have we got to be ready for? Time critical head injuries Massive haemorrhage Chest trauma Abdominal trauma Pelvic fracture Femoral fracture Amputation

9. When?

10. Designation panel visit Jan 2014 Open and detailed discussion in conjunction with the commissioners

11. MTC Organisation EDTheatrePICU/HDUWard Clinical ownershipDefinitive treatmentSurgical specialities Transfusion serviceRadiologyDiagnostic and support services On-goingStarts earlyRehabilitation Team to team communicationOverview, bed organisationPaediatric trauma Nurse co-ordinator

12. Delivery to Definitive Care A dedicated patient lift connecting: – Burns unit – PICU – Theatres – CED

13. Major Trauma Nurse Co-ordinator – Champion care – Tracking and recognition of patients. – Co-ordinate journey – Ensure patient ownership – Contribute to education

14. Rehabilitation and on going care AHP Rehab Co-ordinator – Rehab prescription – Co-ordination of rehab for major trauma – Link to neuro-rehab service – Link to Community

15. TARN Submissions approved within last 90 days

16. BRHC Paediatric Trauma Team C CED Doctor A PICU doctor A Paed Anaesthetist B CED Doctor B Patient CED nurse C Patient CED nurse Drug nurse CED Scribe Family liaison Role Radiographer A Theatre Practitioner A PICU Nurse Paed Trauma Team Leader Drug nurse Outreach Orthopaedics Paed surgery Neurosurgery Cardiac surgery Plastics & Burns

17. Teaching program Cascade equipment training. Point of care simulations Time Critical Head injury move to CT. Paediatric Massive Haemorrhage. Chest injury. Video learning tools Preparing for a trauma

18. Since go live on 7 th of May 93 Patients – 69 eligible for BPT 13 Primary Trauma Calls 4 Deaths – Two NAI retrieved to PICU – Out of hospital Arrest awaiting coroner autopsy – Child ejected from car.

19. Patient Activity 93 patients. Of these patients: 56 went to Theatre 32 were Orthopaedic 35 were Neurosurgical 13 arrived via Helicopter

20. Governance Severn Network Children’s Hospital Governance PMTC Lead Peninsular Network Peer review Trauma team leader ‘hot’ debrief Mortality and morbidity meeting PMT Network Lead Child death review process Paediatric Trauma Business/Governance Children’s Hospital Executive Trust Governance

21. M&M Already strong Critical care M&M including PICU and CED. Children’s hospital attendance at Severn network M&M. Plan Paediatric Major trauma M&M quarterly – One joint with Severn Adults MTC – One Joint with Peninsular MTC Geared to maximises learning. 1 st M&M 32 clinicians over 50% consultants.

22. What about the HIT? Gives opportunity to engage with a wider group. – Particularly injury prevention and community services. Research and long term strategy. – Think differently. – Increase collaborations. Sharing of demographic and injury data. Feedback individual narratives to help prevention. Link community and hospital rehab more closely.

23. Any questions?