The Northern Ireland Major Trauma Network (NIMTN) has created regional protocols in order to guide practice and coordinate trauma services between the different HSC trusts in Northern Ireland. [1]

The NIMTN is active on the planning of every aspect of trauma care ranging from the pre-hospital care to the rehabilitation care but we are only going to focus on the emergency transfer protocols for major trauma. A basic principle of the guidance is that the patient should be receiving the right care in the right place at the right time.

Northern Ireland’s Major Trauma Centre is the Royal Victoria Hospital in Belfast and is receiving patients from all other local hospitals in the region.

The relevant protocols in action are the Call and Send Protocol and also the Major Trauma Triage Tool. They aim to define the criteria for direct transfer to a Major trauma centre versus the nearest district hospital and also provide a clear guidance on the process for a transfer of major trauma to the major trauma centre in order to avoid unnecessary delays.

The call and send protocol has been in use since January of 2021 and is an extension of the major trauma triage tool. It uses the injury severity score and facilitates transfer from district general hospitals to the major trauma centre. To be exact, patients with calculated injury severity score more than 15 qualify for expediated transfer to the MTC. That indicates that the patient has at least a single system severe injury or multiple system minor/ moderate injuries. The Local hospital senior ED doctor contacts the MTC where the patient cannot be refused and a hyperacute transfer is arranged.

This protocol reduces the clinical debate of accepting the patient transfer and it provides a direct trauma line for efficient communication.

The Major Trauma Triage Tool aims to direct all major trauma to the MTC to avoid unnecessary delays. Decisions are made against set of criteria for severe injuries including: 1. Vital signs and level of consciousness, 2. high risk anatomy of the injury, 3. mechanism of injury.

If the severity criteria are fulfilled and the estimated arrival time to the major trauma centre is less than 45 minutes then the patient is transferred directly to the MTC.

Further information and the exact protocols can be found on the NIMTN website http://www.hscboard.hscni.net/majortrauma/nimtn-contacts/.

Penetrating buttock injuries are rare but potentially life-threatening injuries [2] and this case highlights learning points around the early management of penetrating buttock trauma, the current transfer protocols and the specific surgical considerations. This report aims to aid doctors consolidate their knowledge around the subject and improve their management of similar situations.

We also aim to raise awareness regarding the Northern Ireland Major Trauma Network transfer protocols that were not available at the time of the event.