Paediatric major trauma - transfer guidance
WYMTN Dec 2020 Paediatric Major Trauma Transfer Guidance can be found here
Happily paediatric trauma is relatively rare, making up about 10% of the total major trauma patient population. The downside to this is that we are all less familiar with managing children with significant injuries. This highlights the importance of centralising care at paediatric major trauma centres. We know however that over 25% of paeds trauma patients arrive at an Emergency Department by private transport - and parents & carers can't be expected to understand the intricacies of major trauma triage.
Within West Yorkshire the same patient pathway applies to adults and children. The key principle is that if a child arrives at a Trauma Unit with injuries that cannot be managed there then they need to be transferred to the MTC in Leeds as quickly and as safely as possible.
Happily paediatric trauma is relatively rare, making up about 10% of the total major trauma patient population. The downside to this is that we are all less familiar with managing children with significant injuries. This highlights the importance of centralising care at paediatric major trauma centres. We know however that over 25% of paeds trauma patients arrive at an Emergency Department by private transport - and parents & carers can't be expected to understand the intricacies of major trauma triage.
Within West Yorkshire the same patient pathway applies to adults and children. The key principle is that if a child arrives at a Trauma Unit with injuries that cannot be managed there then they need to be transferred to the MTC in Leeds as quickly and as safely as possible.
The role of Embrace
Embrace provides a specialist, round-the-clock transport service for critically ill infants and children in Yorkshire and the Humber who require care in another hospital in the region or further afield. They do not provide time-critical transfers and so can't deliver emergency trauma transfers directly. They are able to provide a teleconference co-ordination and advice service and can deliver non time-critical transfers for trauma patients. Examples are given below:
Within North, East and South Yorkshire the process is slightly different in that Embrace are involved in all transfers to the Major Trauma Centre - although YAS will still deliver actual time-critical transfers. This means that the MTC ED consultant may be called by Embrace to take part in discussions around children in Hull, Scarborough and York. In addition some paediatric patients within South Yorkshire (particularly those with vascular and thoracic injuries) will need care that can only be provided at the LGI and again Embrace will be involved in planning these transfers. The flowchart for North Yorks & the Humber MTN can be found here.
Embrace provides a specialist, round-the-clock transport service for critically ill infants and children in Yorkshire and the Humber who require care in another hospital in the region or further afield. They do not provide time-critical transfers and so can't deliver emergency trauma transfers directly. They are able to provide a teleconference co-ordination and advice service and can deliver non time-critical transfers for trauma patients. Examples are given below:
- A child is brought to a WYMTN trauma unit with a head injury. CT reveals an extra dural and the child's clinical condition is deteriorating. The TU team start organising transfer to the MTC and contact the MTC ED consultant to inform them of the transfer. When the patient is ready for transfer the team contact YAS to request a priority one ambulance (within 8 minutes). The TU clinical team will accompany the patient. The TU team contact the on-call neurosurgeon at the earliest possible opportunity to inform them of the transfer. Embrace are not involved in this process.
- A child is brought into a WYMTN trauma unit ED with an abdominal injury after falling onto handlebars. The child is stable but the team are unsure as to whether or not to get a CT and whether or not to transfer the patient. They contact Embrace who organise a teleconference with the on-call paediatric surgeon at the MTC, involving Embrace clinicians and the MTC ED consultant as necessary.
- A child has been admitted to a TU ward for observation following blunt abdominal trauma. They are deteriorating on the ward but remain relatively stable. Embrace are contacted and organise and deliver transfer to the MTC for on-going care.
Within North, East and South Yorkshire the process is slightly different in that Embrace are involved in all transfers to the Major Trauma Centre - although YAS will still deliver actual time-critical transfers. This means that the MTC ED consultant may be called by Embrace to take part in discussions around children in Hull, Scarborough and York. In addition some paediatric patients within South Yorkshire (particularly those with vascular and thoracic injuries) will need care that can only be provided at the LGI and again Embrace will be involved in planning these transfers. The flowchart for North Yorks & the Humber MTN can be found here.