Search

MTCs receiving major trauma patients should have a trauma theatre equipped with a radiolucent operating table that allows fluoroscopic imaging of all body parts without repositioning the patient.

Primary and revision arthroplasty surgery, along with trauma surgery involving bone implants or internal fixation should be carried out in an operating theatre with multiple air changes per hour (e.g. laminar flow).

Appropriate facilities for rest breaks should be provided according to defined norms.^{6,10,11,12,13}

Point of care testing for haemoglobin, blood gases, lactate, ketones, coagulation, viscoelastic measurements and blood sugar should be available during surgery for patients with major trauma and those undergoing orthopaedic procedures associated with a risk of haemorrhage.²⁴ If near-patient testing is not available, laboratory testing should be readily and promptly available.

Use of point of care ultrasound (POCUS) is recommended as a useful adjunct to the primary survey in acute trauma.^{26, 27}

Transport and distribution of blood and blood components at all stages of the transfusion chain must be maintained under appropriate conditions to ensure the integrity of the product.²⁷

Appropriate blood storage facilities should be clearly identified and provided in close proximity to the emergency operating theatre.²⁸

Tranexamic acid should be available for administration if major haemorrhage is suspected in a trauma patient within three hours of injury.^29,31,32

In MTCs with a high volume of patients, prethawed plasma should be immediately available.

In MTCs and TUs there should be a rapidly accessible imaging suite for patients with major trauma, which is equipped with all of the life support facilities available in the emergency room. This will include physiological and gas monitoring; in addition, the room design should allow visual and technical monitoring of the patient by the anaesthetic staff.³⁴