North West Ambulance Service

The reconfiguration of major trauma (MT) services throughout the UK and specifically the North West of England has enabled patients who have suffered major trauma to be taken to the most appropriate hospital to care for their injuries as opposed to the nearest emergency department (ED).

In the North West, the major trauma reconfiguration was introduced in 2012 with a phased implementation of seven major trauma centres (two of which are specialist paediatric centres) and supported by a network of trauma units.

To support the clinical decision making process, NWAS developed a major trauma decision tool (Major Trauma Pathfinder for both adults and children). This allows ambulance clinicians to utilise the tool to aid their decision making when faced with trauma patients. There is also a specialist burns pathway.

Additionally, a similar concept has been developed for the treatment of major burns to facilitate the by passing of local ED’s and even major trauma centres/trauma units where the primary complaint is a significant burn in the absence of polytrauma. There are five major burns centres in the North West: three adult and two paediatric.

Advanced Paramedics

Advanced Paramedics (AP) are a team of advanced practitioners who have enhanced clinical and decision making skills which are utilised in a variety of pre hospital situations.

When attending the scene of a potential or confirmed major trauma incident the primary function of the AP is to provide clinical leadership and overall responsibility for the patients care. The role often necessitates the delegation of treatment to appropriately qualified practitioners to enable the supervision of scene, liaison with other agencies (fire, police, air ambulance, HART).  This also includes communication with the trauma cell as detailed below.

However, a large part of this role is the ability to support a detailed assessment, plan and initiate treatment and decide upon the most appropriate destination hospital to cater for the patients presenting condition.

AP’s also have additional practical clinical skills to assist with critically ill patients requiring additional support at scene. Skills and equipment include:

• Surgical airway
• EZIO – Intraosseous access
• Additional analgesia

Trauma Cell

Arguably the most valuable tool in the decision making process is the Trauma Cell which is staffed 24/7 by a team of AP’s. Situated in the Emergency Operations Centres (EOC) at Broughton and conveniently alongside the air desk, AP’s monitor ALL emergency call’s received across the NWAS region to identify potential major trauma incidents.

During the course of the incident identified, the AP will identify the need for additional resources such as AP, Doctor or Helimed and coordinate as required. Contact will be made with the crew to ascertain if the patient is likely to be a major trauma case and agree upon the most appropriate destination for the patient.

Often, ambulance clinicians will have a patient who does not trigger the major trauma pathfinder but have clinical concerns regarding the condition of the patient. The trauma cell AP is able to advise after talking through the history and mechanism of injury with the clinician on scene. If needed the AP can escalate incidents to either the Consultant Paramedic or one of the Associate Medical Directors (AMD).

After the decision has been made with regards to the patient destination, the AP will liaise with the appropriate MTC or TU to provide a clinician to clinician handover and answer any patient pertinent questions the MTC/TU team leader may have. In the event that a patient has been taken to a TU due to concerns about airway, breathing or circulation then the AP will make contact with the MTC to notify them of the major trauma and will also facilitate the onward transfer of the patient to the most appropriate MTC.