TRAUMA FEATURE estimated £ 300 to £ 400 million lost economic output per year in Scotland as a result of trauma.
As well as having four major trauma centres, a network of trauma units and local emergency hospitals will continue to manage minor to moderate trauma across Scotland.
When people are identified as major trauma patients at the scene of an incident every effort will be made to transport them to the nearest major trauma centre. If they are outwith the 45-minute access threshold to a major trauma centre they might be taken to the nearest trauma unit initially, before being transferred to a major trauma centre. The Scottish Ambulance Service now has a specialist trauma desk to support the management of these transfers.
All these services together create the Scottish Trauma Network as an inclusive equitable trauma network for severely injured patients, aiming to save more lives and improve the lives of patients throughout the trauma pathway – from prevention to rehabilitation
The Aberdeen( North) major trauma centre will be operational from 1 October 2018 and Dundee( East) major trauma centre will follow later in the year. The Edinburgh( South East) and Glasgow( West) major trauma centres will follow in a couple of years.
The key hallmarks of the new major trauma centres for the East and North will be:
• earlier multidisciplinary rehabilitation from day one of admission to the major trauma centre;
• AHP teams will have new posts working in major trauma;
• there will be a collaborative and co-ordinated AHP team starting early and working all along the patient pathway;
• there will be an identified AHP trauma lead to act as conduit on daily ward rounds for sharing information and linking with AHP colleagues for early interventions;
• a single rehabilitation plan will document the rehabilitation needs of severely injured patients and identify how they will be addressed;
• the rehabilitation plan will be initiated within the first three calendar days of admission to the major trauma centre, and this will be an individualised description of rehabilitation needs / recommendations in sufficient detail to inform planning and delivery of on-going rehabilitation / care;
• the rehabilitation plan developed for the North and East networks will, in time, be in an electronic format to allow the prompt transmission of multidisciplinary information throughout the respective networks and allow patients to have their own copies of their rehabilitation plan;
• rehabilitation co-ordinator roles are being introduced to oversee the patient’ s pathway, anticipating and planning for patients’ needs and providing additional support to patients and their families as they move through their rehabilitation pathway;
• there will be essential data collection using standardised data collection tools for audit and commissioning including the Rehabilitation Plan documentation;
• patient reported outcome measures will be carried out at intervals of three, six and 12 months for each patient. As part of the data collection on rehabilition outcomes, functional independence measures and functional activity measures will be collected
James et al( 2018) conducted a qualitative study to examine the lived experience of OTs working in emergency departments( EDs). Nine OTs with experience of working in EDs participated in semi-structured interviews. Data were analysed using an interpretative phenomenological analysis framework. Two main themes were identified:‘ On the factory floor’, encapsulating the environmental aspects of working in the ED; and‘ A stranger in a strange land’, capturing what it was like to establish a new role in the ED and cultural aspects of the environment. The authors identified that participants
EVIDENCE LINK experienced working in the ED as personally and professionally challenging; but that it also offered rewards. They conclude there is an inconsistency regarding the establishment of the OT role within the ED, and that further evidence is required to understand how OTs construct their professional identity.
Reference James K, Jones D, Kempenaar L, Preston J, Kerr S( 2018) Occupational therapists in emergency departments: a qualitative study. British Journal of Occupational Therapy, 81( 3), 154 – 161
throughout the patient pathway. These may be used to inform key performance indicators over time;
• it is intended that specialist AHPs at the major trauma centre will support AHP colleagues in the community, to support patients; and
• rehabilitation will include vocational rehabilitation and supported return to work. With the new challenges of working earlier in the acute patient pathway, and with patients presenting with more complex needs, occupational therapists, with their AHP colleagues, are currently reviewing their approaches and therapeutic interventions for best practice. They may be required to update their skills and knowledge and to support new staff.
References
British Society of Rehabilitation Medicine( 2013) Specialist rehabilitation in the trauma pathway: BSRM core standards. Available at: https:// bit. ly / 2zy3D9r
Scottish Trauma Network( 2018) National implementation plan. Available at: https:// bit. ly / 2QcIrLt
Wendy Greenstreet, lead OT in acute services in Aberdeen Royal Infirmary North MTC, Claire Tester, OT, seconded as the AHP Improvement Adviser East MTC, and Alison Gilhooly, programme manager for the Scottish Trauma Network. Email: wendy. greenstreet @ nhs. net, claire. tester1 @ nhs. net or alison. gilhooly @ nhs. net. For more information on the Scottish Trauma Network visit: www. scottishtraumanetwork. com
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