From overseas battlefields to terrorist incidents at home: how specialist major trauma teams are saving lives
In recent weeks, specialist major trauma teams at hospitals in London and Manchester have been mobilised to treat people with injuries resulting from three terrorist incidents. Advances in major trauma care and plastic and reconstructive surgery mean it’s much more likely that these patients will survive and recover from their injuries than even ten years ago. Mr Shehan Hettiaratchy, trauma lead and consultant plastic, hand and reconstructive surgeon at Imperial College Healthcare NHS Trust, explains why.
As the Trust’s trauma lead, I oversee our role at St Mary’s Hospital as one of a network of major trauma centres across England that treat patients with the most severe injuries.
A major trauma patient is someone who experiences a severe life-threatening or life-altering injury to any area of the body such as the head, chest, abdomen or skeleton. It can be sustained as a result of accident, sport or violence such as the terrorism we’ve experienced recently. More often than not, in order to successfully treat these patients, multiple specialties need to be involved in their immediate care. For example, a road traffic accident victim may need an emergency operation where an orthopaedic surgeon and a plastic surgeon work together in order to save their leg.
In recognition of the specialist skills and resources needed to treat these patients, a network of 27 major trauma centres was created across England in 2012 to provide specialised trauma care and rehabilitation. The units are staffed by consultant-led trauma teams that meet the patient on arrival at the hospital and have immediate access to the best diagnostic and treatment facilities, including blood transfusion, CT scans and emergency operating theatres.
St Mary’s is one of four major trauma centres in London. Patients suffering from major trauma will not be taken to their nearest A&E but to their nearest available trauma centre. We provide round-the-clock services for both adults and children living in north west and central London – although we often take people from further afield. We see an average of eight trauma patients every day.
With advances in medicine and technology, patients are now able to survive injuries that would previously have killed them. Research into the impact of the major trauma network by the Trauma Audit and Research Network in 2015 found that the odds of a major trauma patient surviving in England were over 60 per cent better in 2014/15 than they were in 2008/09. This is down to the very advanced clinical skills that are available in a range of specialties in major trauma centres like St Mary’s.
Applying advances in military medicine
We have applied lessons learnt from treating wounded soldiers in the field in Afghanistan to develop the NHS major trauma approach. I worked as a surgeon in Camp Bastian in Afghanistan as part of a dedicated trauma team. We treated an endless cycle of major trauma patients, which over time enabled us to finesse our skills and techniques. Everything we learnt in the field has enabled us to provide a more effective trauma service back home. Over the last 10 years in particular we have seen major advances in military medicine and how best to care for severely injured casualties.
One of these advances is how we use blood in a major trauma situation. Some ambulance teams now have blood on board, which means patients can receive blood before they get to hospital. People with traumatic injuries are often at high risk of bleeding to death immediately after their injury. Having blood and blood products available at the scene when an ambulance arrives, or on the way to the hospital, means patients have more time to get to a trauma centre because the blood they are losing is being replaced ahead of or during the journey.
We’ve also seen developments around carrying out quick and effective surgery. This is known as ‘damage control surgery’ and it has been key to improving survival rates. The idea behind ‘damage control surgery’ is that a trauma surgeon operates as quickly as possible to restore normal function in critically ill patients in order to stabilise their condition. If we go back in time to just after the second world war, this approach was actually dismissed as poor surgical practice.
Plastics – a million miles away from cosmetics
Plastic surgery plays a huge role within major trauma. The term plastic comes from the Greek word plastikos which means to mould. When someone talks about plastic surgery, people automatically think of cosmetics. But plastic and reconstructive surgery focuses on rebuilding the body after damage – what we do is a million miles away from cosmetic surgery. The damage could be caused by an accident or even an illness such as cancer. It also involves other areas like correcting birth anomalies, such as cleft lip. My job involves reconstruction of the body, mainly arms and legs, after injuries such as those caused in road traffic accidents.
Our extremity reconstruction service at the Trust rebuilds people’s limbs after trauma, and our outcomes are some of the best in the world. We also do a lot of cancer reconstruction after breast, head and neck, and other cancers.
One of the less common procedures in plastic surgery is a free tissue transfer, as we see in episode one of Hospital. This is where we move tissue from one part of the body to another to reconstruct missing tissue. We then use microsurgery to connect up the blood supply to the tissue that has been moved. There aren’t many major trauma teams that do this but our team will complete one of these complex procedures most working days.
Recovery from trauma and from plastic and reconstructive surgeries doesn’t end in the operating theatre. Every day we work with physiotherapists, occupational therapists, speech and language therapists and dieticians, all of whom play a key role in helping our patients recover and get on with their lives.