The Patient Journey Acute Care
What is a Major Trauma Centre?
Major Trauma Centres (MTCs) are hospitals that are designated to provide definitive care for the most severely injured patients 24-hours a day, seven days a week. They have the facilities and specialist services needed to manage complex injuries and recovery.
In Cheshire & Merseyside, patients with suspected major trauma are usually conveyed to the MTC following a pre-hospital assessment by the North West Ambulance Service (NWAS). Patients may also self-present, and some patients are transferred in from other hospitals, known as Trauma Units, if it has been established that the patient’s injuries are severe enough to require the services of the MTC.
Adult MTC services are provided by a collaboration between Aintree University Hospital and The Walton Centre.
Children's MTC services are provided by Alder Hey Children's Hospital.
Further information about our Major Trauma Centres and Trauma Units is detailed below.
Adult Major Trauma Centre Collborative
Within Cheshire and Merseyside, Adult MTC specialist services are provided by a collaboration between Aintree University Hospital (NHS University Hospitals Liverpool Group) as the single receiving site, and The Walton Centre NHS Foundation Trust, who provided specialist Neurosurgical cranial and spinal management for major trauma patients.
Although separate organisations, teams work across both sites to ensure that all injuries are managed by the appropriate specialist teams.
Aintree University Hospital Emergency Department receives adult major trauma patients via road or air ambulance services.
Major Trauma care is led by Consultant Trauma Team Leaders who work closely with a team of Major Trauma Specialist Nurses.
Aintree provides 24-hour access to specialist trauma teams including:
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Anaesthetists
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Operating Department Practitioners
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Orthopaedic Surgeons
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Emergency General & Trauma Surgeons
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Emergency Medicine Doctors
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Emergency Department Nurses and Health Care Assistants
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Radiology staff and several other speciality teams
The team will assess and stabilise severely injured patients and ensure that patients are receiving appropriate care and timely interventions, depedent on the severity of injury sustained, such as CT scanning, medical interventions, or transfer to emergency theatres.
Specialist assitance may somtimes be required by teams not based at the Aintree site, a list of these provider organisations can be found on the "About Us" section.
As Aintree receives the largest volume of major trauma patients, they have a dedicated, 21 bedded Major Trauma Ward, where major trauma patients will receive daily reviews from the multi-disciplinary / multi-professional team consisting of:
- Consultants (both Orthopeadic and Emergency Trauma Surgical)
- Major Trauma Specialist Nurses
- Ward Nurses and Health Care Assistants
- Junior Doctors
- Advanced Clinical Pharmacist
- Specialist Pain Nurses
- Clinical Psychologist
- Day One Trauma Support Case Worker
The Major Trauma Ward also benefits from a dedicated ward-based Therapy Team.
This team provides Physiotherapy and Occupational Therapy assessments and rehabilitation programmes early in the patient’s hospital admission. The Therapy Team are integral to identifying patients who may require an extended period of rehabilitation in one of the Cheshire & Merseyside Rehabilitation Network specialist units, identifying patinets who may require community therapy input or ensuring patients are safe for discharge back home or into another care facility. The ward-based therapy team supported by wider Allied Health Professionals, such as Speach and Language Therapists, Dieticians, Orthotics and Prosthetics teams.
The Walton Centre admits approximately 300 major trauma patients per year for specialist cranial and spinal management following traumatic incidents such as road traffic collisions, falls or assaults.
A multidisciplinary team (MDT) including Neurosurgeons, Specialist Nurses, Advanced Practitioners and Allied Health Professionals work together to treat and manage these patients.
As with the Aintree site, The Walton Centre has a dedicated Major Trauma Therapy team, who will assess the patient’s rehabilitation needs, determine treatment plans and goals, and will support discharge planning or refer patients to the Cheshire & Merseyside Rehabilitation Network, if an ongoing period of rehabilitation is required.
The Walton Centre have developed Nurse-led Spinal Clinic Follow-up, run by Advanced Nurse Practitioners for patients who require outpatient reviews following spinal trauma.
The Walton Centre runs a combined neurosurgical and neuro-rehabilitation clinic known as the Neurotrauma Clinic. This clinic is run by a Consultant Neurosurgeon, and a Rehabilitation Consultant. Clinics are also held by the Head Injury Advanced Practitioner. This clinic was initiated to support traumatic brain injury sufferers with longer term post-traumatic symptoms in an outpatient setting. New referrals to the Neurotrauma Clinic are first triaged by the Head Injury Advanced Practitioner.
Alder Hey Children's Hospital
Alder Hey Children's Hospital is one of Europe's biggest and busiesst children's hospitals and is the Major Trauma Centre for all children and young people under 16 years of age.
Alder Hey provides specialist major trauma services for all children and young people from across Cheshire & Merseyside, parts of Lancashire & South Cumbria, North Wales and the Isle of Man 7 days a week.
Children and young people can be taken directly to Alder Hey or transferred from a local hospital.
Similar to Aintree, Alder Hey Children's Hospital provides 24 hour access to specialist trauma teams, including:
- Emergency Departmnet Trauma Team Leaders
- Emergency Departmnet Nurses and Health Care Assistants
- Peadiatric Surgeons
- Neurosurgeons
- Anaesthetics and Operating Department Practitioners
- Orthopaedic Surgeons
- Radiologist and Radiographers
As well as access to several other speciality teams.
Following a truamtic injury Alder Hey's aim is to get your child back to, or as close to, their pre-injured health. To do this there are a range or rehabilitation specialists who complete a multi-disciplinary/multi-professional team response, including:
- Physiotherapists
- Occupational Therapists
- Speach & Language Therapists
- Specialist Pain Nurses
- Clinical Psychologists
During a child's hospital stay their care will be supported by a 7-day Major Trauma Coordination Service. These are senior nurses or allied health professionals who act as your child's key worker and will be the link throughout their entire hospital stay, providing support on discharge and ongoing care beyond Alder Hey. As part of the keyworker role, they will alos liaise with nursey or school to formulate a plan for return which will include returning to activities and/or sport.
Further information about major trauma in children can be found via the North West Children's Major Trauma Network website.
What is a Trauma Unit?
A Trauma Unit is a hospital that is part of the Major Trauma Network and has two functions:
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To provide lifesaving interventions to patients who are too unwell to bypass the nearest hospital and need to have interventions to stabilise them before they get transferred to the Major Trauma Centre.
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To manage patients who sustain traumatic injuries, but do not meet the threshold to be taken directly to the Major Trauma Centre. It is recognised that the largest number of patients who sustain traumatic injuries do so from falls, are frail and aged over 65 years. Not all these patients should be taken directly to the Major Trauma Centre as they won’t necessarily require the specialist input that’s offered there.
If injuries that require specialist management by the teams at one of the regional Major Trauma Centre sites are identified by the Trauma Unit team, there are process in place to refer the patient, and a decision will be made as to whether the patient should be transferred or if they can be managed at the Trauma Unit.
Why are they being transferred?
Patients with multiple injuries including broken bones and internal injuries will predominantly be transferred to the Aintree site.
Patients who require Neurosurgical input following serious head or spinal injuries may be transferred to Aintree for further assessment prior to being transferred to The Walton Centre or they may be admitted directly The Walton Centre for emergency treatment.
Following identificaton of injuries, the team at the Trauma Unit will have discussed with colleagues at the Major Trauma Centre and it would have been agreed that the patinet would benefit from the specialist treatment provided at one of the Major Trauma Centre sites.
The Trauma Units in Cheshire &
Merseyside are:
- Arrowe Park Hospital (Wirral University Teaching Hospital NHS Foundation Trust)
- Countess of Chester Hospital NHS Foundation Trust
- Nobles Hospital (Isle of Man)
- Royal Liverpool Hospital (Liverpool University Hospitals NHS Foundation Trust)
- Southport & Ormskirk Hospital (Mersey and West Lancashire Teaching Hospitals NHS Trust)
- Warrington Hospital NHS Foundation Trust
- Whiston Hospital (Mersey and West Lancashire Teaching Hospitals NHS Trust)
Links to organisations websites can be found on the Network Map.
Will patients stay at the Major Trauma Centre?
Patients may stay at the Major Trauma Centre site until they are suitable for discharge back home, into specialist rehabilitation or other care facilities.
On ocassion they may return back to their local hospital for a period of further recovery or discharge planning once it has been confirmed they no longer require the specialist care provided by the Major Trauma Centre.
Decisions around appropritness for a patient to be transferred back to their local hospital, known loally as “Reverse Transfer”or “Repatriation”, if the patinet is to be transferred to a hospital outside of the Cheshire & Merseyside region, will be made on an individual patient basis, and will involve the full major truama multidisciplinary team. This allows for patinets to continue their rehabilitation closer to home while awaiting access to rehabiltation or other care facilities, and also supports flow at the Major Trauma Centre sites, ensuring there is capacity for the MTC to accept other patinets who require their specialist services.