INTRODUCTION - TRAUMA PROTOCOLS FOR NORTHERN IRELAND
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.