Doctors at the John Radcliffe Hospital have joined an innovative new scheme to bring them closer to patients at trauma scenes. MATT OLIVER reports
FROM serious road accidents to a life-threatening sports injury, trauma doctors are right on the frontline of duty.
When treating a patient with major injuries, time is of the esscence, particularly at the John Radcliffe Hospital.
In 2012, the site was designated a “major trauma centre” by the Government – meaning people who are injured in a way that could result in death or serious disability, head straight there.
Since then Oxford’s world-class medical centre has been dealing with the most seriously-injured patients across the Thames Valley, 24 hours a day, seven days a week.
To improve care and lighten the load on an ever-pressurised accident and emergency (A&E) department, two new schemes have been introduced since 2012.
Doctors are now being taken along with paramedics in air and land ambulances, as part of the Helicopter Emergency Medical Service (HEMS) and the Enhanced Care Response Unit (ECRU).
The crews stabilise patients before they are taken to hospital and can make important decisions before they arrive, to save time later on.
In many cases patients can be taken straight to a specialist unit.
Dr Syed Masud is a consultant in emergency medicine and pre-hospital care at the John Radcliffe and is also clinical director for trauma across Oxfordshire, Berkshire and Buckinghamshire.
He has been putting together the new scheme for a year-and-a-half and it was finally put into action in December.
He said that if doctors are taken to the scene with paramedics, they can make clinical decisions earlier that improve a patient’s chance of survival.
“We are tasked with going to the most critically-injured patients. Our primary objective is giving them the best possible standard of care and by doing this [scheme] we are giving advance treatment at the earliest point.
“It means we do not waste time and can tell what is wrong with patients sooner.
“Often we do not need to go through A&E because they can go straight to the speciality department that they need.
“There are many aspects of this programme that can save time and there is no doubt that includes pressure on A&E.”
Trauma is a key battleground for the NHS, because it is the leading cause of death among younger people aged 36 and below.
National Audit Office figures from 2010, the most recent, claim that in England, the most common cause of death is by road accident.
In Oxford, according to the Trauma Audit & Research Network, the John Radcliffe dealt with 1,002 trauma cases in 2013 – a 36.7 per cent increase on the previous year.
And the hospital actually performed better than expected, with one extra patient surviving out of every 100.
Dr Masud explained that the new ride-out scheme is not taking doctors away from the hospital’s roster during critical peak times in in-patients.
“Many of the doctors are on rotas and timetables that are adjusted so they do the same amount of hours in the hospital, but they have time to do other things such as going out with the ambulances for training.
“It does not take them away from A&E when it matters.
“Most doctors will do one or two days a month. And very senior doctors who attend major trauma incidents will go with the air ambulances on HEMS.
“ECRU cars work in the same system, though, and will also go anywhere.”
In some cases, he said, rapid response cars can even be sent to people in minor injuries who have been referred to A&E, where the doctors and paramedics on board can assess whether they definitely require hospital care.
“Hospital is not always the right place for a patient,” said Dr Masud.
The project has also required an enormous amount of cooperation between Oxford University Hospitals Trust, which runs the John Radcliffe and the many other NHS facilities in the city, and South Central Ambulance Service.
Medical director John Black said: “We are fully supportive of this new partnership, which is leading to significant improvements in clinical outcomes for patients.
“With this additional enhanced medical care capability, the ambulance service is able to directly transport these patients to specialist units, which is important for accessing complex time-critical care.
“These teams are able to support our ambulance clinical staff in providing high-level care en route to hospital that helps to ensure that these patients arrive safely and in the best possible condition.”
The service has even taken the partnership further, with a pilot involving 60 clinical medical students from Oxford University. They have been working as community first responders.
Mr Black added: “It has given those involved a fantastic understanding of the challenges of providing and delivering pre-hospital care. And we are looking to further develop the pilot and build on its success.”
SPECIAL CARE AT THE JR
Trauma care is given to patients who have sustained serious physical injuries due to accidents.
The John Radcliffe Hospital has a dedicated trauma unit which provides around-the-clock care.
It includes two specially-designed trauma wards with clinics for fractures, and hand and spinal injuries.
Radiological facilities – such as X-rays, radiography and ultrasound – are also available for investigation into patient injuries.
In some trauma and orthopaedics cases the hospital also works with the Horton General Hospital in Banbury and uses surgeons at the Nuffield Orthopaedic Centre in Headington for spinal injuries.
Trauma statistics from the John Radcliffe Hospital 2011 – 697 cases 2012 – 733 cases 2013 – 1,002 cases
CAUTION URGED ON BOOKINGS FOR CORN EXCHANGE
THE Corn Exchange in Witney will not be available for function bookings until April next year.
Witney Town Council maintains it wants the Market Square building open by the end of the year but said it has to be “realistic” about when it can be used for events such as weddings.
The Grade II-listed building was closed suddenly in November 2011 after a safety inspection uncovered serious health and safety problems.
At a meeting of the council’s public halls committee on Tuesday, chairman Roger Curry said: “We’re working hard to get it open by the end of the year.
“There may be some slippage because something might arise in the construction work. We think it might be realistic to say April as a date when we could say we’re reasonably confident that we could accept a wedding booking.
“We can keep using Langdale Hall through April and longer so there will be an overlap.”
Mr Curry said the Corn Exchange will have the same facilities as Langdale Hall, which is to be put up for sale “shortly” to fund the Corn Exchange refurbishments, including a bar, stage, kitchen and parking.
Reopening the building has been delayed after asbestos was found earlier this year but work ro remove it is expected to begin next month.
PARAMEDICS' EFFORTS COULDN'T BE FAULTED
KERRY Hyatt thinks the treatment parademics provide at trauma scences can’t be bettered – even by a doctor.
In May 2012, Mrs Hyatt was run over in a supermarket car park while she was returning a trolley.
Kerry Hyatt in hospital with husband James in 2012 after she was run over in a supermarket car park
She broke two bones in her left leg and shattered her shin bone in her right leg.
“I can’t say that [having a doctor present] would have improved the service,” said the Witney mother-of-three.
The paramedics gave her morphine and put splints on her legs, she said.
Mrs Hyatt’s then 10-year-old daughter, Charleigh, heard her mum’s screams as she waited in the car.
Mrs Hyatt was taken to the John Radcliffe Hospital, where she stayed for two weeks to receive further treatment.
She has since fully recovered from the incident.
'HAVING A DOCTOR AT AN EMERGENCY IS A FANTASTIC IDEA'
SIMON Howell thinks that having doctors accompany paramedics can only be of benefit to the treatment of patients at the scene of an accident.
“The idea of having a doctor with them is a fantastic idea,” said Mr Howell, 62, of North Leigh, near Witney.
Simon Howell with his 'lucky' shorts
The married father-of-one son believes the presence of a doctor would help.
“Think about a car accident where somebody suffers whiplash,” he said. “A doctor would look at that instantly.”
Mr Howell’s situation was less straightforward.
In August 2013, the director of campaigns at the British Dental Health Foundation was cleaning his yacht at a boatyard in Topsham, Devon. The aluminium ladder broke and, as he fell, one of the ladder’s legs acted as a knife, slicing a five-inch wide cut into his upper leg.
He also broke two ribs in the fall. “I couldn’t believe the pain, it was just awful.”
Mr Howell believes the pair of rugby shorts he was wearing saved his life, because the double-stitching prevented the ladder from penetrating further.
'QUALITY OF CARE WAS AMAZING'
Oxford Brookes University masters graduate Joe Robinson, 23, was given just a three per cent risk of survival after a serious car crash on the A34 five years ago.
He and three friends, all pupils at St Edward’s School in Oxford, were being driven home from a night out when the driver, who had been drinking alcohol, veered off the carriagway and into a barrier.
The resulting collision killed the 17-year-old passenger, critically injured Mr Robinson, then 18, and left the fourth passenger with minor injuries.
Mr Robinson, pictured, said he owes his life to the paramedics who got him to the John Radcliffe Hospital shortly afterwards.
He said: “If it was not for them getting me out of there and to the hospital so quickly I might not be alive.”
The crash had broken his back in three places, neck in two places and caused a skull fracture that ran halfway across his head.
He was given just a three per cent chance to live.
Mr Robinson said: “I had been the third person to be pulled from the vehicle and I was taken by ambulance to A&E. The quality of care I received at that critical point was amazing throughout.
“They knew exactly what to do about my condition, it was great to know there were experts looking after me.
“Sending doctors out with the paramedics is a brilliant idea, because then they can do on-site diagnosis and prepare someone for hospital.”
After leaving hospital, Mr Robinson was in a wheelchair and has seen a range of therapists to help with his mental recovery.
In 2013 he graduated from Exeter College with a 2:1 degree in Geography and he is due to collect his masters from Oxford Brookes in real estate this month.
He added: “ I feel enternally indebted to the [paramedics] and staff at the John Radcliffe.
“I can’t stress enough how exceptional they are.”
Delays in A&E are a major concern for health managers in Oxfordshire as they can have a knock-on effect on other departments.
Figures released for the 12 months to March show Oxfordshire was the worst area out of 151 in England.
And in May 8.2 per cent of occupied beds were blocked. The target is 3.5 per cent.
Bed blocking occurs when the continued presence of patients in A&E beds, due to a shortage of space elsewhere, prevents others from being seen.
An average 128 were blocked at one time and the latest snapshot survey, on June 19, recorded that 104 were blocked.
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