In MTCs and TUs there should be a rapidly accessible imaging suite for patients with major trauma, with immediate access to specialised equipment for the management of difficult airways including physiological and gas monitoring. In addition, the room design should allow visual and technical monitoring of the patient by the anaesthetic staff.38
In MTCs and TUs, the resuscitation room receiving bays should be large enough to allow simultaneous emergency procedures to be performed by trauma team members.
Hospitals admitting patients with major trauma should have critical care to both Level 2 and 3 standards on site.39 Portable invasive haemodynamic monitoring should be available to facilitate transfer to and from the critical care areas.
Anaesthesia for the emergency control of major traumatic haemorrhage, and other damage limiting interventions in the operating theatre or radiology intervention suite, should be consultant anaesthetist led. Where consultants are not resident, clear lines of communication and notification should be in place to allow early attendance to trauma calls.
A major trauma coordinator (or someone in a similar role) should be responsible for overseeing scheduled admissions, preparation and planning for surgery, and for coordination of care of trauma patients with other specialties including critical care and postoperative care.
Rapid and effective communication is crucial in emergency situations. Communication strategies should consider the use of technologies such as smart phones, and standardised methodology such as situation, background, assessment, recommendation.29
Patients who have sustained rib fractures should have an early multidisciplinary assessment involving multidisciplinary teams such as surgeons, pain services, critical care and physiotherapy to determine the optimal analgesia and definitive management options to minimise complications related to altered pulmonary mechanics, lung capacity and ventilation.
There should be a flexible approach to trauma list planning and management to accommodate emergency cases that need priority treatment. There should be a system in place to alert the theatre team of the arrival of an unstable patient with major trauma. Appropriately trained staff and facilities should be available to receive these patients at short notice.18
The trauma team should attend to all suspected major trauma, according to the predefined local criteria. The trauma team should also be present for paediatric and older patients (where appropriate), patients with unexpected findings on arrival and to receive patients following interhospital transfer.
