New concepts in trauma practice

The speakers on the second day of the trauma conference tackled questions related to the organisation of trauma systems and topical clinical subjects. Trauma organisation was addressed by speakers from very different perspectives. Professor Mark Midwinter, Defence Professor of Surgery spoke on Surgical Lessons from Recent Conflicts. He discussed the importance of managing trauma from the point of injury on the battlefield to rehabilitation at home. He described damage control through the chain of evacuation as a ‘single process, with a single objective’. The military have developed an efficient system treating trauma as ‘a disease with it’s own pathophysiology, management, options, skills and competencies’. Back in the UK, Professor Karim Brohi, London Trauma Network Director updated on UK Trauma Systems Development. He identified public consultation and legislation as crucial in network development ‘designed to improve quality and access of care by concentrating services’. Professor Brohi was positive that progress has been made but commented that ‘there is a long way to go and this will take time’ He cited TARN as essential in informing future change and the next speaker Professor Fiona Lecky research director of the Trauma Audit and Research Network (TARN) was challenged to debate if trauma registries have lost their way. A systematic analysis of TARN and other trauma registries showed evidence that data collection and accurate analysis has saved lives, but maintaining independence in the future is crucial in providing impartial and robust data. Mr Rob Bentley, London Rehabilitation Director, presented The Challenge of Rehabilitation. He discussed the commissioning failures for trauma rehabilitation in the UK and the need to raise the priority of rehabilitation. Data from London clearly demonstrates the poor match between requirement and supply of rehabilitation services. He described how a rehabilitation pathway is being developed in London with help from TARN returnable processes, data and outcome measures, influenced by successful rehabilitation programs in stroke and cardiac medicine. The eminent Professor Jim Ryan delivered a global perspective on trauma in a reflective keynote address. He described a ‘public health problem of pandemic proportions’ with an annual mortality of 5.8 million, 10% of deaths worldwide. He went on to discuss the impact of natural disasters, complex humanitarian emergencies and conflict. We are living in the ‘most destructive period of human history’ with 70 national/international conflicts currently being fought and terrorism on an unprecedented scale. The burden of these events is born by the least prepared and resourced countries, the social impact often greatest on the most vulnerable. He concluded by reminding us of the responsibility to share advances and expertise in trauma care worldwide. The 3 Peter Baskett Memorial Lecture was delivered by Professor Michael Parr from Australia. He discussed The Highly Performing Trauma System: How good can we get? and highlighted that trauma systems need to produce a complete process and that data is a powerful tool in how that system matures. He drew on his experience at the Liverpool Hospital, Sydney to illustrate how trauma system performance can be optimised. Improvements made by standardisation of protocols, procedures, audit and education foster consistency and quality. The professor advocated the concept of the RAPTOR (Resuscitation with Angiography, Percutaneous Techniques and Operative Repair) suite, a one-stop treat all room utilising pioneering technology. He closed by arguing passionately that we all have a role to play in the education and prevention of trauma and showed a video entitled ‘Dumb ways to Die’. The light-hearted cartoon with catchy tune kept the room entertained, but there was a clear accident prevention message for audiences of all ages. He concluded that it takes 10 years or more to develop a great trauma system, was positive Bristol, UK Full list of author information is available at the end of the article Salm and Hommers Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 2013, 21(Suppl 1):A9 http://www.sjtrem.com/content/21/S1/A9