Delays in care of the critically injured

✍ Scribed by Dr B. P. McNicholl; C. H. Dearden

• Publisher: John Wiley and Sons
• Year: 1992
• Tongue: English
• Weight: 329 KB
• Volume: 79
• Category: Article
• ISSN: 0007-1323
• DOI: 10.1002/bjs.1800790226

✦ Synopsis

Prehospital and resuscitation periods and times to emergency surgery were studied in major trauma victims over two 12-month periods to identifv factors causing delay in emergency care. Eighteen patients required emergency surgery in thejrst group and 13 in the second. The mean presurgery time (i.e. time from arrival in the accident and emergency department to surgery) was 11 7 rnin in the j r s t group and 111 rnin in the second. Causes of delay included a sequential approach to resuscitation and investigation, limited stafl and theatre availability, and failure to call the trauma team. Times for resuscitation and times to surgery could be reduced by earlier decision-making, alerting key personnel promptly and performing tasks in parallel.

All services dealing with major trauma should audit their performance to discover those factors that contribute to the reported preventable mortality rate of 67 per cent for injuries not involving the central nervous system (CNS) and of 17 per cent for CNS-related injuries'. Previous audit of performance in the management of major trauma in the accident and emergency department of the Royal Victoria Hospital, Belfast highlighted many deficiencies in the management of major trauma'. Changes in medical staff, the introduction of the Revised Trauma Score as a triage tool, and the creation of a 'trauma team' brought a significant improvement in patient management3. This study measures the duration of the prehospital and presurgical phases (including time in the accident and emergency department and time en route to surgery) and analyses their relationship to type of injury and causes of delay.