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Local guidelines for patient transfers between referring hospitals, neurosurgical units and local ambulance services should be consistent with national guidelines for the safe transfer of the brain-injured patient.⁴⁴

Immobilisation equipment including a range of appropriately sized semi rigid collars, head blocks, tape, a vacuum mattress and a scoop board should be available. Spinal clearance should be achieved as soon as clinically possible, to minimise discomfort and complications from prolonged immobilisation in patients who do not have spinal injuries.

In suspected spinal injury, hard spinal boards should only be used as a prehospital extrication device and not be used for transport.³² A scoop stretcher or full-length vacuum mattress should be used for transfer.

Equipment for portable monitoring to level 3 standards and ventilation should be available in the ED resuscitation room.^33,34

Point of care ultrasound (POCUS) should be available as it is a useful adjunct to the primary survey in acute trauma. Operators need to ensure that this procedure does not delay time to definitive imaging or intervention.^2,27,35

Patients who have acute nerve or spinal cord compression should be referred immediately to a neurosurgeon or specialist spinal unit (where required).³⁶

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

For patients with complex trauma, including spinal cord injuries and traumatic brain injury, there should be rapid access to key professionals and regional specialists. Patients, relatives and carers should be directed to appropriate support groups where relevant e.g. the Spinal Injuries Association.³⁷

An emergency operating theatre should be rapidly available at all times for major trauma patients. The available equipment should be suitable for a full range of emergency trauma procedures. Use of this theatre for non-urgent procedures should be tightly controlled. If the designated emergency theatre is occupied, there should be a robust, flexible and agreed backup plan to obtain an...

The emergency operating theatre should be equipped with a radiolucent operating table that allows fluoroscopic imaging of all body parts without repositioning the patient.