Introduction by National Clinical Lead

Annual report time arrives once again, and in this new style of presentation my superlatives for the work of all who support the continued work, development and improvements of the Scottish Trauma Network will be brief. This is just as well, as the resources of my thesaurus begin to abate.

It is now 5 years since we convened and commenced our program of work to build and implement an entirely new clinical network of acute care and long-term rehabilitation for Scotland’s most seriously injured. August 30th 2021 witnessed the completion of Phase I with delivery of the fully operational end product. At time of writing, we run smoothly and successfully in the best traditions of “National Collaborative Pragmatism”.

All of this achieved of course, against the backdrop of complications presented to us by the pandemic. A remarkable achievement now recognised and acclaimed at the highest levels of the NHS, the Scottish Government, and national and international media.

This hard-earned and well-deserved reputation requires stiffening of the sinews and strengthening of resolve to be maintained, for us to progress further as we contribute well beyond our remit to the Remobilisation of the NHS in Scotland.

Thus, now begins Phase II, where we plan to tell the story using data, to raise standards for the future, and to demonstrate the sustained improved outcomes for patients, their families, their communities and the nation as a return on the visionary investment of these past 5 years.

The full report can be seen here

Martin McKechnie

National Clinical Lead

Scottish Trauma Network

Introduction from National Clinical Lead

2020 – 21 has been variously difficult, challenging, interesting and rewarding across the many spheres of activity, development and progress for the Scottish Trauma Network (STN). This Annual Report sits alongside and complements the imminent publication of the Scottish Trauma Audit Group’s (STAG) Annual Report for the same period. They both reveal and explore much of the data, operational and patient-centred clinical stories around this past year’s extraordinary activity within the Network. Set against the pandemic backdrop, the strong message coming from these reports is one of resilience, maintained high-quality patient care and an above-and-beyond spirit of collaboration and pragmatism on a national scale. That key performance and outcome measures have been delivered, yet alone maintained and improved in several areas, is worthy of acknowledgment and appreciation. The reports further explore much of our presentation and discussion at the Scottish Parliament Health and Sport Select Committee in January 2021.

There are many examples to celebrate, but I take this opportunity to highlight and express admiration and gratitude to the Scottish Ambulance Service, the ScotSTAR and EMRS transport and retrieval arms, and the newer Advanced Paramedics in Critical Care red teams therein. Their relentless and complex work in supporting and enabling the pandemic response across trauma and all related critical care services has been inspiring. The STN and patients are thankful to them beyond words. These thanks are expressed in equal measure to all staff and services recruited in good faith and optimism to the STN, yet who found themselves redeployed and reallocated to support the response in other vital areas such as Emergency Departments, Trauma Wards which became Covid High Dependency Units and Critical Care areas, and Theatres.

More interesting still is what much of this tells us about the improved access we now have to data and patient-reported measures. These are the mainstays of why the STN does what it does. With STN Trauma and STAG coordinators now embedded in our hospitals, we are able to reach more broadly across and deeper into the care of trauma patients than ever before. The resulting information and its analysis will further “tell the story” as we move beyond delivery of Phase I later this year, with the opening of the Major Trauma Centres at the Queen Elizabeth University Hospital in Glasgow, and the Royal Infirmary of Edinburgh, and the operational delivery of the Regional Networks in the West and South East of Scotland. These final pieces of the jigsaw will complete the national picture alongside the MTCs at Aberdeen Royal Infirmary and Ninewells Hospital in Dundee opened in 2018, supporting all the component services within our Regional Networks.

It is to be hoped that by the time of next year’s report we will be able to reflect upon a time of challenge and change with a more secure feel for what the immediate and medium-term future holds for our service. This learning allows us to reenergise and reconvene with strength, determination and the confidence that comes from surmounting such a significant hurdle.

Every person and every collaborative and linked service involved, described and embraced within the following pages is deserving of the greatest of gratitude and recognition. We are indebted to you all.

The full report can be seen here.

Martin McKechnie

National Clinical Lead

Scottish Trauma Network

The Major Incidents with Mass Casualties (MI-MC) Group met on two occasions during August, with the second of these meetings focussing on shaping the new national plan.

Planning basis 

The new plan focuses on the following:  

• Sudden impact incidents resulting in large numbers of casualties with trauma injuries;
• NHS Scotland’s response to a MI-MC as a single, integrated entity, in conjunction with Health and Social Care Partnerships (HSCP);
• Delivery of an appropriate and timeous response to the needs of children and adults in order to secure the best possible outcomes for them;
• An assumption of health and social care services responding simultaneously to 175 Priority (P)1 and P2 (i.e. seriously injured) casualties, and hundreds of P3 ( ‘walking wounded’) casualties;
• A 21-day period post incident, and the process towards the recovery phase.

Progress towards preparedness

Plans for treating paediatric P1 and P2 casualties have been outlined to prevent Paediatric Centres being overwhelmed and to make the best use of skills and facilities in such situations. The Group has also set out where facilities for P3 casualties should be sited so that NHS Boards can make plans accordingly.

The roles of HSCPs, reflecting the broad span of their responsibilities, and of General Practitioners, including GP Out-of-Hours Services, during a MI-MC situation are in the process of being agreed. A model for involving Rehabilitation specialists in the treatment of casualties at an early stage has also been identified as a feature of the plan acknowledging the importance of this specialism in securing the best possible outcomes for patients.

NHS 24 will be at the forefront of the health and social care response to a MI-MC, assisting with public messaging, signposting P3 casualties and families to appropriate services, or supporting them directly by using its special helpline capability. Relevant (pre-prepared/ready-to-push-out) materials and protocols for a range of scenarios are currently being developed for the plan. Work is also being progressed to ensure that there will be synergy and consistency in messages that will be issued at various stages between NHS 24, Scottish Ambulance Service, NHS Boards and Police Casualty Bureau.

Work is underway to ensure that there is appropriate capacity and access to Psychological Trauma and Bereavement Support Services within health and social care services across Scotland for victims and families in the aftermath of MI-MC incidents.

Digital / technological solutions to assist response efforts are being explored, including a patient-tracking system (to monitor the movement of patients from scene of incident through their hospital stay) and a Bed Dashboard (to real-time monitor hospital specialist bed capacity).

For further information contact Ray de Souza sghru@gov.scot  or  nss.scottrauma@nhs.net

The Major Incidents with Mass Casualties Group met for the third time on 20 June. A range of capability issues were the focus of discussion.

Prioritised actions

A Casualty Distribution Planning Workshop for territorial NHS Boards took place on 24 July. Attended by NHS Board delegations comprising clinicians, management and resilience leads, and representatives of other health specialist areas (Burns and Blood Transfusion), the audience benefited from hearing the ‘lived experience’ of two senior clinicians involved in managing casualties from the Manchester Arena attack. NHS Boards have now begun the process of determining the number of seriously injured (P1 and P2) patients to be distributed to receiving hospitals during the first hour following a major incident with mass casualties (MI-MC). This work is to be completed by 7 September.

Some of the challenges of responding to the needs to children and their families continue to be worked through by a multidisciplinary task group.

Focus on preparedness

An assessment is being carried out of the range of medical supplies and equipment that will be required by NHSScotland during a MI-MC; this work includes identifying how they can be readily accessed and replenished when necessary.

A proposal by the Burns Network in Scotland for treating burns-injured patients during a MI-MC situation is being considered by the group. Its aim is to enhance the capability of local acute hospitals by dispatching specially trained clinical and nursing staff to local facilities rather than moving burn-injured patients to specialist units. The proposed model seeks to provide best possible care and outcomes for patients and alleviate pressure on services.

Key lessons and other relevant issues from the Salisbury chemical poisoning incident continue to be reviewed and used as the basis for ensuring NHS Board’s preparedness for such events.

The challenges and issues for remote and rural areas during MI-MC situations are being reviewed with the aim of ensuring that the new national plan appropriately and effectively meets their needs.

Work has been progressed with Police Scotland’s Scottish Casualty Bureau (SCB) to develop effective collaboration between the NHS/Health and Social Care Partnerships and the SCB during a MI-MC situation.

For further information contact Ray de Souza sghru@gov.scot or nss.scottrauma@nhs.net

The second meeting of the STN Major Incidents with Mass Casualties (MI/MC) Group was on 30th April, and the bulletin can be found here.

The STN’s Major Incidents with Mass Casualties (MI/MC) Group had its first meeting on 22 March.

This is a partnership between Scottish Government Health and Social Care Directorates, NHS Boards, Health and Social Care Partnerships (HSCP) and Local Authority Chief Social Work Officers under the auspices of the STN. Its task is to produce a new national plan that sets out how health and social care services will come together to respond to the needs of adults and children during a major incident with mass casualties.

Download the Major Incidents with Mass Casualties Group bulletin here.