Chapter 1 - Severn Major Trauma Network

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The Major Trauma Network

Major trauma describes serious and often multiple injuries. It is a common cause of mortality and morbidity and remains the most common cause of death in the population under the age of 40. The development of integrated trauma networks has aimed to organise regional major trauma care in a way that provides coordinated multidisciplinary care at a time and place that benefit the patient the most. Each region has developed a network of hospitals based upon available facilities and transfer times. This has led to the designation of three tiers of hospital providing trauma care: Major Trauma Centres, Trauma Units, and Local Emergency Hospitals. There are 26 Major Trauma Networks in England, each with a Major Trauma Centre. Major Trauma Centres are designated to deliver high quality speciality care and have all the facilities to provide resuscitation, emergency surgery, and interventional radiology with consultant-led trauma teams 24/7. Pre-hospital teams now use major trauma triage tools to identify patients who may have suffered severe injuries and require direct transfer to the Major Trauma Centre. Southmead Hospital is one of two designated Major Trauma Centres in South West England, servicing the Severn region. The Major Trauma Centre is supported by six acute trusts as designated trauma units: ‣ Bristol Royal Infirmary ‣ Gloucestershire Royal Hospital, Gloucester ‣ Royal United Hospital, Bath ‣ Great Western Hospital, Swindon ‣ Musgrove Park Hospital, Taunton ‣ Yeovil District Hospital

Severn Major Trauma Network

The Severn Trauma Network serves an adult population of around 2.3 million. The South West has a greater proportion of inhabitants of pensionable age than any other English region (19.6%) and this is reflected in network data. The average age of major trauma patients treated in the network is 65. The majority of major trauma patients across the network are treated as the result of a fall from less than 2m. Road traffic collisions are the second most common cause of injury, followed by falls more than 2m.

Major Trauma Automatic Acceptance Policy

Key points

This policy will relate to patients from Trauma Units and Local Emergency Hospitals within the Severn Major Trauma Network area following major trauma ‣ The Severn Major Trauma Network must accept all severely injured patients in a timely manner ‣ This policy applies seven days a week, 24 hours a day ‣ Capacity constraints cannot be used over clinical priority to turn-down or delay patients ‣ The final responsibility for the implementation of this policy lies with the on-call Major Trauma Consultant (Trauma Team Leader). ‣ The Retrieve Adult Critical Care Transfer Service provides triage and co-ordination of all adult critical care transfer referrals 24/7 and should be contacted whenever a critical care transfer is required

Introduction and Purpose of the Policy

Following the introduction of Regional Major Trauma Networks, Major Trauma Centres are required to have an automatic acceptance policy for patients requiring treatment for major trauma injuries. The purpose of this policy is to provide direction and guidance for actions from key individuals and organisations within the Severn Major Trauma Network to improve the patient pathway and quality of care. To do this it will: ‣ Ensure the automatic acceptance of major trauma patients after consultant to Trauma Team Leader (TTL) referral within the Severn Trauma Network from Trauma Units to the Major Trauma Centre ‣ Ensure that all relevant parties are aware of their specific roles and responsibility, and prevent the acceptance and transfer of patients being delayed ‣ Describe the procedure where capacity to accept severely injured patients is exceeded.

Application: To Whom This Policy Applies

This policy will relate to patients from Trauma Units and Local Emergency Hospitals within the Severn Major Trauma Network area following a major trauma injury. This policy applies to referring trusts hospitals, ambulance trusts and local air ambulances. It is the responsibility of North Bristol NHS Trust staff to ensure that that this policy is followed from first contact by an outside agency. The policy will be implemented by personnel in the Emergency Department, Intensive Care, High Dependency Units and General Wards. The final responsibility for the implementation of this policy lies with the on call Major Trauma Consultant (TTL) who accepts the patient. The trauma team leader can be contacted on 07703 886400. Departure from the policy would have to be justified to the Executive On call manager with clear and compelling reasons. Any departure from the policy must be documented in the patient notes and flagged through the major trauma governance process – MTGovernance@nbt.nhs.uk

Principles

This policy applies 7 days a week, 24 hours a day All relevant clinical information is to be given to the receiving Trust The Retrieve Adult Critical Care Transfer Service provides triage and coordination of all adult critical care transfer referrals 24/7 and should be contacted whenever a critical care transfer is required. All adult critical care transfer referrals should be made to Retrieve via their single point of contact telephone number (0300 030 2222) In certain circumstances (at night and when the Retrieve team are committed elsewhere), the referring Trauma Unit will be required to undertake the transfer, providing appropriately trained and experienced clinical escorts and using a 999 ambulance (accessed via Retrieve). The transfer of the patient is to be organised by the referring hospital, providing necessary escort arrangements, together with all necessary documentation including the Severn Major Trauma Network trauma patient record. This policy should be read in conjunction with: ‣ The Severn Major Trauma Network repatriation policy ‣ SWASFT Major Trauma Triage Tool ‣ Inter-Hospital Transfer of Critically Ill Adult Major Trauma Patients ‣ Major Incident Policy

Automatic Acceptance Process for Emergency Transfers

In the case of an emergency transfer the referring hospital must contact the on-duty Major Trauma Consultant (TTL - 07703 886400) with details of the patient. The referring hospital must also inform the Ambulance Service Coordination desk of the transfer and details of the patient. Retrieve should be contacted for any critical care transfers. The transfer procedure must be carried out at TTL level Full patient details including name of referring TTL and time of referral to be recorded in the Major Trauma booklet 15 Patient notes including their Major Trauma booklet should be transferred to the receiving hospital with the patient. On arrival, the patient is met by the major trauma team and trauma call procedures initiated

Capacity and Overflow Management

The Severn Major Trauma Centre has a duty of care to the population covered by the Severn Major Trauma Network and must accept all severely injured patients in a timely manner. Timely is defined as according to the urgency of transfer as defined by the Trauma Team Leader only. Where there are problems with capacity in specific areas of NBT (such as critical care) to accept patients from the Severn Major Trauma Network, it is the responsibility of the affected unit/department to inform the TTL in a timely manner and to work together to resolve the situation expediently. Capacity constraints cannot be used over clinical priority to turn-down or delay patients. In the unlikely event that a patient at a Severn Trauma Unit required a Major Trauma Centre Bed and the patient cannot be accepted at NBT because of capacity (such as during a major incident) it is the responsibility of the NBT TTL to ensure that an alternative bed can be sourced in another Major Trauma Centre (in conjunction with the Ambulance Service Coordination centre). The decision of whether a patient requires immediate major trauma centre care (and therefore must be accepted) is made by the TTL. If no other Major Trauma Centre within clinically acceptable transfer time can accept the patient then North Bristol NHS Trust must accept the patien

Single Call Access Numbers

NBT Trauma Team Leader (Consultant): 07703 886 400 SWASFT Ambulance Co-ordination Desk: 0845 1206342 Retrieve: 0300 030 2222

Mass Casualty and Major Incident

The North Bristol Trust Major Incident Plan includes mass casualty response. In addition to this, there are Emergency Department, ICU, and Theatre Major Incident Plans detailing department response. The Emergency Department plans include a clear role of the trauma team and team leader with additional and supporting roles. Responders should familiarise themselves with their local guidelines for the management of major incidents. NBT guidelines can be viewed on the Trust intranet and include: ‣ Major Incident Plan ‣ Major Incident Action Cards ‣ Major Incidence Guideline for Anaesthetists ‣ ED15 - Managing a Major Incident ‣ Major Incident Plan for Theatres - initial response

Methane Report

The Trust is notified of a major incident by the Ambulance Service via an automated system to the Emergency Department. Information regarding the incident is communicated using the METHANE mnemonic which provides key information needed to inform the Trust’s response: 1. Major Incident Standby / Declared 2. Exact Location 3. Type of Incident 4. Hazards—both present and potential 5. Access and egress to the incident 6. Number of casualties and a breakdown of types i. Priority 1 (P1), life threatening injuries, resus ii. Priority 2 (P2), urgent, non life threatening, majors iii. Priority 3 (P3), delayed, minors iv. Number of children, burns etc 7. Emergency Services already at scene or involved in responding to the incident On receipt of the Major Incident Notification, the Emergency Department documents the METHANE and initiates the appropriate response as outlined in the Major Incident Plan. 17 INITIAL MASS CA

Initial Mass Casualty Distribution Plan

Principles Influencing Triage: ‣ Number and type of casualties ‣ Location of the incident within the network ‣ Neurosurgery only at NBT, cardiothoracic services at UHBW (one thoracic surgeon will receive patients at NBT). Specialised children’s services at BCH.

Severn Casualty Capability Chart: Pre-determined capacity for the first 2 hours

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Total capacity for Severn (200). Ideally: ‣ Priority 1s to MTC ‣ Priority 2s to trauma units (but TUs may also have to take priority 1s) ‣ Priority 3s to TU’s, LEH’s and other appropriate facilitates. These figures relate to the first 2 hours and should be viewed in the context of incidents producing mass casualties: within small incidents the figures for each unit will be lower.

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Mass Casualty Management Considerations

All receiving hospitals should ensure they enact plans to enable them to free up 20% of their total bed base, 10% of which should be in the first six hours, and a further 10% within 12 hours of the incident declaration, allowing patients from the incident scene to be rapidly placed and ensure patient flow. In addition to this, hospitals with level 3 Intensive Care capability should prepare to surge to double their normal level 3 ventilated bed capacity and maintain this for a minimum period of 96 hours. Trauma Units should be prepared to manage patients who they would usually treat and transfer for extended periods, along with preparing to receive additional repatriations from the MTC. During a mass casualty incident, it may be necessary for receiving hospitals to expand their emergency capacity into space not usually occupied by the emergency pathway. This will require the activation of business continuity measures. Organisations will need to consider activation of their lockdown arrangements to support site security and the need to protect access to health care facilities to those in need of treatment. In the event of being in a scene cordon the hospital may be asked to act as a temporary rest centre or reception centre.

Hospital Reporting

Trusts should be prepared to provide the information required on the NHS England National Incident Situation Report Template, or specific incident template issued during the incident to the appropriate time scales.

Mortuary Services

National arrangements for the identification of victims are likely to be invoked. These may include the activation of National Emergency Mortuary Arrangements (NEMA) or the designation of a Designated Disaster Mortuary (DDM) which may be on NHS premises but operated by the local authority. It may be the case that the mortuary space in NHS hospitals has to be managed carefully, and coordinated with the appropriate HM Coroner’s Office, HM Police and Local Authority to maintain capacity. This will be important where deceased are to be held for a period of time, and there will be delays in taking hospital mortuary bodies to the designated disaster mortuaries

Clinical Cell (CRG)

NHS England will form a Clinical Cell with the Duty Clinical Director along with representatives of the NHS England EPRR Clinical Reference Group, with additional specialist representation as required. This cell will act to ensure that the NHS England Incident Management Team (National) has the appropriate access to clinical advice to inform the response. NHS England may make use of Medical Directors from Regional Offices and DCO teams to support the clinical cell in a protracted incident or where they have specialist subject advice required of the response. In addition to this, NHS England may contact individual experts to offer advice based on available known staff in organisations. Clinical Impact Assessment Call Within the first twenty-four hours of an incident, the Lead National Medical Director will establish a clinical call with responding centres to ascertain the likely impact to services and patient management across all services. An agenda for this is provided in Annex 6: Clinical Impact Assessment Call Agenda Where possible this call will be held on the secure teleconferencing facilities accessible through the NHS England EPRR Duty Officer (NHS05). Ethical Decisions It may become necessary to enact decisions relating to the ceilings of care during a mass casualty incident to ensure the greatest number of survivors possible. This may include the decision by the Clinical Cell to invoke the expectant triage category at the scene. This decision will be time limited, continually under review and only used at a time when NHS resources are overwhelmed Patient Placement The Clinical Cell will advise on the placement of patients who need to be transferred out of the incident response areas to ensure they receive the most appropriate definitive care. Clinical Debrief The Clinical Cell will establish a clinical debrief for the incident, the hot debrief will be held within two weeks of the incident, with a structured clinical debrief within one month. Recovery Cell Nationally a Recovery Cell will be established to coordinate with the response and ensure work is undertaken to manage the recovery of NHS England and the NHS in England. This group will look at the recovery support required and ensure liaison between recovery groups at all levels of the organisation and out to those groups established as part of SCG response.

Recovery Considerations

Decision making for return to normal working ultimately rests with Incident Director (National). This may be delegated as the incident response evolves and recovery commences to regional leads; however, the option to refer to the designated national lead should remain in the case of local/regional dispute or unacceptable variation in recovery actions occurs. ‣ Financial implications must be transparent, and principles applied consistently across the system by providers and commissioners ‣ Recovery should be led by a senior Regional Recovery Lead and coordinated nationally across the health economy to ensure continued application of mutual aid principles, effective use of resources and to facilitate repatriations ‣ National, regional and local recovery leads should liaise at an early stage and throughout the process with ODNs. The ODNs will provide local intelligence and advise on actions to be taken at system level (local/regional/national) ‣ Return to organisational business as usual may take considerably longer than normal. ‣ Trauma cases may require multiple and prolonged returns to surgery and/or stays in critical care. ‣ Specialist services may need to be commissioned or expanded to deal with additional demand on a medium to long term basis ‣ Patients may need to be repatriated into their own health economy a long way from the incident location and may require medium to long term care and rehabilitation. Commissioners will need to agree the provision of additional resources. ‣ National support will be required to recover costs from overseas patients and national arrangements should be set out in advance. Costs may be for short, medium or long term care and treatment and could include; emergency and/or specialist treatment and care, rehabilitation services and repatriation. ‣ Discussions around the reduction, alteration, suspension or cancellation of services by organisations supporting the incident that impact on their national standards should be conducted between regulators at a national level. ‣ Proactive capture of points to inform learning from response and facilitate recovery should be achieved.

Debriefing

All NHS organisations involved in the response will be expected to undertake a debrief as per the requirements of the NHS England EPRR Framework and Core Standards. Trusts may be invited to multiple debriefs by many agencies and should attend these where possible.

Psychosocial Support

Psychosocial support should be offered to patients and staff as needed they should also be made aware of those symptoms that are normal during the initial period following a traumatic event, An NHS England post incident leaflet is available ‘Access to post incident mental health services leaflet’. NEED HYPERLINK TO THE LEAFLET

Background Information

Risk factors and likely injury types National planning assumptions state the likely split across triage categories will be 25% Priority 1 (casualties needing immediate intervention), 25% Priority 2 (casualties needing early treatment but delay acceptable), 50% Priority 3 (casualties needing treatment but a longer delay is acceptable). The cause of the incident is likely to dictate the type of injury from a Mass Casualty event however there is likely to be: ‣ Severe Blunt Force or Ballistic Trauma (especially in firearms and bomb related incidents) across specialties. ‣ Burns ‣ Acoustic Injuries (where blasts have occurred) Environmental Local conditions can impact on the ease to get to medical facilities and the ease of access to patients requiring a greater response from the hospital. Weather conditions can impact on the number of casualties in an incident and the type of treatment and staff required to respond, extremes of temperature can increase the risk of shock, and bring about exposure related illness. Water Supplies Water supplies could be the cause of a mass casualty incident or impacted upon by an incident. The Trust has in place utility disruption plans to allow services to continue in the event of a disruption or contamination to supplies. Advice should be sought from Public Health England during any incident of this nature. Lack of water supplies may require a change in the way patients are cared for and effect immediate treatment. VIP Visits It is likely during and/or following a mass casualty incident there will be significant interest from VIPs to visit hospitals and those affected. This may need to be coordinated nationally to ensure that appropriate arrangements are in place. Visits from VIPs can require extensive resourcing and organisations need to carefully consider these against the need to deliver ongoing patient care.

Network Repatriation Policy

Introduction and Purpose of the Policy

The repatriation of major trauma patients to their local hospitals has the potential to be challenging for the patient, carers and organisations involved. Unnecessary delays are unhelpful in a number of ways: ‣ They can impede care packages for patients ‣ They can be inconvenient or distressing for both patients and relatives ‣ They are a source of frustration in relationships between hospitals ‣ They can prevent acutely ill patients being admitted into designated beds ‣ Can affect patient flow and operational running of the Major Trauma Centre (MTC) The purpose of this policy is to provide direction and guidance for actions from key individuals and organisations to reduce the challenge and improve the patient pathway and quality of care for major trauma patients. It also aims to replicate the automatic acceptance principle that ensures acceptance of patients from the Trauma Units (TU) to MTC during the early phase of care. It will provide the MTC with an effective means of returning patients to their original or local Trust following their initial acute treatment and therefore ensure capacity is available in the MTC for any further patients requiring major trauma care.

Scope

The policy will be formally agreed and accepted amongst all organisations within the Severn Trauma Operational Delivery Network (ODN) and relate to those patients admitted to North Bristol NHS Trust (MTC) following major trauma. This policy applies only to TARN inclusion criteria major trauma patients. For operational purposes, major trauma patients are those that have been received following triage according to the Major Trauma Triage Tool (Page 45). It does not apply to patients other than those deemed to have major trauma injuries at time of transfer.

Summary of the Policy

The policy will ensure that all patients are repatriated to their local health care provider when they are medically fit or have completed specific treatment at the MTC. It will ensure that all relevant parties are aware of their specific roles and responsibilities and prevents delay to patient transfer. It will provide clear guidance for action when patient pathways become blocked.

Principles

The process outlined in this policy applies twenty-four hours, seven days a week to all organisations within the Severn Trauma Network. ‣ The MTC is committed to automatically accepting major trauma patient transfers into the centre. As such to maintain flow it is critical that there is a robust and reliable process for repatriation to TU. A principle of automatic acceptance for repatriations needs to be approved by TU. ‣ MTC clinical teams will make contact with the receiving Trust clinical team and agree the transfer and acceptance of care using the Repatriation Notification Form (Page 26). ‣ The MTC and other hospitals should maintain communication throughout the patient’s stay at MTC as appropriate. ‣ The MTC will provide as much notice as is reasonably possible of repatriation and endeavour that this is no less than 48 hours before repatriation is required. ‣ All relevant clinical and social information is to be provided to the receiving Trust upon referral. ‣ An escalation policy will be triggered if a bed is not allocated to a major trauma patient within 24 hours of them being ready for transfer. ‣ Transport will be organised by the MTC, providing necessary escort arrangements, together with all necessary documentation including a formal typed discharge summary to accompany the patient. ‣ If the patient has critical care needs, transport arrangements can be discussed with Retrieve – 0300 030 2222. ‣ Lack of rehabilitation facilities within the receiving organisation should not affect the repatriation of patients. 24 ‣ A patient must be accepted by a senior doctor (ST3 and above) doctor within the specialty required before the repatriation process can begin. Please note that for quadriplegic patients returning to hospitals within the Network an accepting consultant in the receiving specialty is required.

Escalation Procedures

24 Hours If repatriation has not occurred within 24 hours of patient being fit for transfer, then the Operations Manager at the MTC will be informed and will communicate with the Operational Lead at the receiving Trust. Out of hours this will be the site team lead or the manager on call. 48 Hours If repatriation has not occurred within 48 hours of patient being fit for transfer, then the Deputy Director of Operations at the MTC is to be informed and communicate with their equivalent at the receiving Trust. 72 Hours If following discussion between Directors of Operations, no agreement can be reached, a time for repatriation will be established by the MTC approximately 72 hours from patient being ready for transfer and this will be confirmed with the Trauma Unit, who must identify a receiving team and ward, the patient will then be transferred.

Review

This policy will be monitored jointly by all Trauma Unit clinical and managerial leads and the Severn Major Trauma Operational Delivery Network Board. A formal review will be undertaken annually, and amendments will be made as necessary.

Major Trauma Notification Form

Major Trauma Repatriation Notification Form

Major Trauma Centre Coordinators to Complete Top Section and Email to Receiving Trust nominated email address.

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External Quality Assurance

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FSH, LH, Prolactin, macroprolactin, AMH
Thyroid
UKNEQASFluids (total protein, albumin, glucose, amylase, creatinine, urea, lactate, total cholesterol, triglyceride)

UKNEQAS

Urine Chemistry (electrolytes, osmolality, protein, calcium, albumin)

UKNEQAS

CSF Spectroscopy scheme

German Scheme RfB

Blood spot 17OH progesterone 

ERNDIM

Acylcarnitines in Serum (carnitine)

ACDB scheme (Acylcarnitine’s in dried blood spots, includes interpretation)

ERNDIM

DPT Scheme (Diagnosis Proficiency Testing)

ERNDIM

Special assays in urine (GTL)

ERNDIM

QLOU scheme (Qualitative Organic Acids in urine)

ERNDIM

Quantitative amino acids 

ERNDIM

Quantitative methyl malonic acid (ORGS) (urine)

ERNDIM

Quantitative special serum assays (hydroxybutyrate, phytanate, VLCFA, pristanate, 7-dehydrocholesterol, free carnitine, NEFA ) 

ERNDIM

CN, PHE and TYR in dried blood spots

Centre for Disease Control (USA)

CDC DBS galactose-1-phosphate uridyltransferase (GALT)

UKNEQAS

Newborn screening includes following blood spot markers (TSH, IRT on the GSP)

UKNEQASNewborn screening for markers Phe, Tyr, C8 , C10,  C8/10

UKNEQAS

Sickle Cell

LGC International Proficiency SchemeAntipsychotics/SSRI/TCA
Carboxyhaemoglobin
Case studies for toxicology
Ethanol (blood, urine, serum)
Paracetamol
Tacrolimus, Cyclosporin and Sirolimus 
Toxicology
Serum Toxic Alcohols 
UKNEQAS

Cholinesterase inhibitor and activity
MSS Down's screening (First trimester)
Trace metals (Chr, Co, Cu, Pb, Se, Zn)

RIQASUrine drugs of abuse
Equalis (Swedish)Iohexol 
  
  
  
  

Immunology

Scheme Provider

Scheme

UK NEQAS

Paraneoplastic Antibodies

UK NEQAS

B2Microglobulin

UK NEQAS

C1 Inhibitor and Functional Complement

UK NEQAS

Monoclonal Protein Identification

UK NEQAS

General Autoimmune Serology

UK NEQAS

Nuclear and Related Antibodies (Hep2)

UK NEQAS

Nuclear and Related Antibodies (rodent tissue ANA and critidia)

UK NEQAS

Bullous Dermatosis

UK NEQAS

IgG Subclasses

UK NEQAS

Total IgE

UK NEQAS

Allergen Specific IgE

UK NEQAS

ANCA/GBM Antibodies

UK NEQAS

Coeliac Disease Antibodies

UK NEQAS

Diabetic Markers

UK NEQAS

Specific Proteins Dist

UK NEQAS

CSF for Oligonclonal Bands

UK NEQAS

Faecal Markers of Bowel Inflammation

UK NEQAS

CSF for Beta 2 Transferrin

UK NEQAS

Alpha 1 Antitrypsin Phenotyping

UK NEQAS

ACHR Antibodies

UK NEQAS

Phospholipid Antibodies

UK NEQAS

Mast Cell Tryptase

UK NEQAS

Fungal Related Antigens

UK NEQAS

Immune Monitoring CD4 Counts

UK NEQAS

Leukaemia Immunophenotyping

UK NEQAS

Leukaemia Interpretation Scheme

UK NEQAS

MRD ALL

UK NEQAS

Interferon Gamma Release Assay - TB

UK NEQAS

PNH

UK NEQAS

Allergen Component Testing

UK NEQAS

ABO Titration

UK NEQAS

Scheme 1B HLA-B27 Testing

UK NEQAS

Scheme 2B  Crossmatching by Flow Cytometry - B cell

UK NEQAS

Scheme 2B  Crossmatching by Flow Cytometry - T cell

UK NEQAS

Scheme 3 HLA Antibody Specificity Analysis

UK NEQAS

Scheme 4A1 HLA DNA Typing 1st Field Only

UK NEQAS

Scheme 6 Antibody Detection

UK NEQAS

Scheme 7 HLA-B57:01 Typing

UK NEQAS

Scheme 8 'Disease' Typing HLA-DR/DQ/DP only

UK NEQAS

Cryoglobulin (pilot)

UK NEQAS

Myositis Associated Antibody

UK NEQAS

Faecal Pancreatic Elastase

UK NEQAS

MRD CLL (pilot)

UK NEQAS

MRD AML (pilot)

UK NEQAS

Educational Crossmatch Scheme

WEQAS

FOB/FIT (pilot)

UK NEQAS

Phospholipase A2 Receptor Antibody

UK NEQAS

CSF Immunophenotyping (pilot)

UK NEQASAlkaline Phsphatase (ALP) Isoenzymes (pilot)

 

Cellular Pathology

Scheme Provider

Scheme

UK NEQAS

UK NEQAS for Cellular Pathology Tecnique - General

UK NEQAS

UK NEQAS for Cellular Pathology Tecnique - Cytology

UK NEQAS

NEQAS for Immunohistochemistry - General

UK NEQAS

NEQAS for Immunohistochemistry - Lymphoma

UK NEQAS

NEQAS for Immunohistochemistry - Breast

UK NEQAS

NEQAS for Immunohistochemistry - HER2

SW Regional EQA

SW Regional EQA Papanicolaou in Cervical Cytology

SW Regional EQA

SW Region Cervical Cytology scheme

National scheme

HPV

National Gynaecological Histology Scheme

Interpretive Schemes pathologists practising in speciality

Regional Histopathology EQA Scheme

Interpretive Schemes pathologists practising in speciality

GI Pathology EQA Scheme

Interpretive Schemes pathologists practising in speciality

Bowel Cancer Screening

Interpretive Schemes pathologists practising in speciality

National Uropathology EQA Scheme

Interpretive Schemes pathologists practising in speciality

National Dermatology EQA Scheme

Interpretive Schemes pathologists practising in speciality

National Prostate Core EQA Scheme

Interpretive Schemes pathologists practising in speciality

National Renal Pathology EQA Scheme

Interpretive Schemes pathologists practising in speciality

National Renal Transplant EQA Scheme

Interpretive Schemes pathologists practising in speciality

Regional Cervical Cytopathology EQA Scheme

Interpretive Schemes pathologists practising in speciality

 

Haematology

Scheme Provider

Scheme

UK NEQAS

Full Blood Count

UK NEQAS

G6PD

UK NEQAS

Auto WBC Differential

UK NEQAS

Retic Count

UK NEQAS

Haemoglobinopathy

UK NEQAS

Sickle Screen

UK NEQAS

Cytochemistry, FE Stain

UK NEQAS

Blood Film Morphology/Parasitology

UK NEQAS

Manual WBC Differential

UK NEQAS

Rapid Malaria Antigen Test

UK NEQAS

nRBCc

UK NEQAS

Plasma Viscosity

UK NEQAS

Ferritin

UK NEQAS

Intrinsic Factor Antibodies

UK NEQAS

B12/Folate

UK NEQAS

Erythropoietin

UK NEQAS

INR/PT

UK NEQAS

APTT

UK NEQAS

Thrombin Time

UK NEQAS

Heparin Dosage Assessment

UK NEQAS

Heparin Assay

UK NEQAS

Fibrinogen

UK NEQAS

D-Dimer

UK NEQAS

Coagulation Factor Assays: VIII, IX II,V,VII,XI,XII,FXIII
(Assay & Screen), VIII (Quantitative Inhibitor)

UK NEQAS

VWF RiCof VWF antigen

UK NEQAS

Antithrombin Activity

UK NEQAS

Protein C Activity

UK NEQAS

Free Protein S Antigen

UK NEQAS

Activated Protein C resistance

UK NEQAS

Lupus Antigoagulant

UK NEQAS

Blood Transfusion

UK NEQAS

BTLP (Blood Transfusion)
(Grouping, Crossmatching, Antibody Investigation, DAG)

UK NEQAS

FMH (Blood Transfusion) Acid Elution

ECAT (Dutch EQA Scheme)

Anti-Xa tests

 

SMTN Research

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Research ongoing through the Severn Network linking to Major Trauma.

ELABS

Research Division: ASCR

General overview of study: A multi-centre randomised controlled trial of both the effectiveness and cost-effectiveness of the treatment of hypertrophic burn scars with Pulsed Dye Laser (PDL) and standard care compared to standard care alone.

Funded by: NIHR

Principal Investigator: Jonathan Pleat

Patient Group: Patients with ≥1% TBSA burn wound grafted or conservatively managed

For additional information: Please contact MTTraining@nbt.nhs.uk

COMITED

Research Division: Emergency Department

General overview of study: Conservative Management in Traumatic Pneumothoraces in the Emergency Department (CoMiTED). This is a Randomised Controlled Trial

Funded by: NIHR Health Technology Assessment Programme

Principal Investigator: Edd Carlton

Patient Group: Aged, or believed to be aged 16+ with Traumatic Pneumothoracies in whom the treating clinician(s) believed either chest drain or conservative management is a suitable treatment

For additional information: Please follow the link CoMiTED – Conservative Management in Traumatic Pneumothoraces in the Emergency Department (CoMiTED): A Randomised Controlled Trial (bristol.ac.uk)

SMTN Paediatric Nursing

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Paediatric Major Trauma Competencies Study Day – Level 1 (Network)

This single day study event will provide an introduction to the following topics: Overview of Major Trauma networks, the influence of Human Factors on teamwork, ABCDE of Paediatric Major Trauma Care, Trauma skills stations &Trauma simulations. This is a chargeable course – approx. £50 per attendee.

Duration: 1 day

Target candidates: This event is aimed at nursing staff with minimal or no experience of Paediatric Major Trauma. Attendees will be working within an Emergency Department/ working in a different department who may be called to assist with a paediatric trauma.

For enquiries please contact: FacultyOfChildrensNurseEducation@UHBristol.nhs.uk

Paediatric Major Trauma Competencies Study Day – Advanced (Network)

This single day study event will build on your existing knowledge and prior experience of major trauma. Topics include: Advanced Airway Skills, Neuro-assessment/Spinal Shock, Bereavement and Organ Donation, Burns, Human Factors Elements of Senior Nurse Role &Trauma Simulations. This is a chargeable course – approx. £50 per attendee.

 

Duration: 1 day

Target candidates: This event is aimed at nursing staff with a minimum of 2 years emergency nursing experience. Attendees will be working within an Emergency Department/working in a different department who may be called to assist with a paediatric trauma.

 

For enquiries please contact: FacultyOfChildrensNurseEducation@UHBristol.nhs.uk

SMTN Nurse and AHP Training

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Trauma Immediate Life Support (TILS)

The TILS study day encompasses lectures, workstations & Trauma moulages where all the skills learnt during the day are consolidated in simulation. The candidates are not expected to undertake skills or roles during the day that they don’t undertake in real life, the course helps standardise the care & treatment that each major trauma patient will receive regardless of day/ time of attendance.

Duration: 1 day, 6 times per year at MTC.

Target candidates: All nurses within the Emergency department will complete. New Band 5 nurses starting in the emergency department will be booked into the TILS study day within 6 months of starting their post. There will be a trial period of opening this course up to junior doctors in the Emergency department and wards. Each trauma unit should have their own TILS course implemented with resources provided by the MTC but network places can be made available to support units as required. 

For enquiries please contact: EDEducationTeam@nbt.nhs.uk

Trauma Immediate Life Support (TILS) - Recert

To be completed approx. 2 years after TILS. Recap on Trauma skills with new workshops and simulations.

Duration: 1 day, 6 times per year at MTC.

Target candidates: All nursing bands that have completed TILS.

For enquiries please contact: EDEducationTeam@nbt.nhs.uk

Neuro Study Day Level 1

Neuro ward study day. Provides an overview of brain anatomy, seizure management, clinical skills including Glasgow Coma Scale assessment, log rolling and hard collar application. Spinal cord injury and autonomic dysreflexia. Brain haemorrhages, neuro psychology and neurogenic bowel and bladder, EVD/lumbar drain management and FVC.

Duration: 7.5 hours, run quarterly

Target candidates: Nurses from 6b, 7a, 25a, 34a, 34b

For enquiries please contact: Abigail.Lindsay@nbt.nhs.uk : Book on LEARN

Trauma and Musculoskeletal study day

Plan to develop a trauma course with an emphasis on musculoskeletal trauma, and wider areas of major trauma care including special circumstances, psychological aspects, deteriorating patients and chest drain care and management.

Duration: 7.5 hours, run bi-yearly

Target candidates: Nurses from 25a, 6b, ICU, 33a, open to other wards receiving trauma

For enquiries please contact: mttraining@nbt.nhs.uk

25A in situ SIM and clinical skills - Development of a Level 2 Emergency Department Severn Network Course

Adapted from the Musgrove Park hospital course. This is a comprehensive course mapped to the level 2 requirements in the NMTNG competencies. Would need to be PEER reviewed by the NMTNG once established and running.

Duration: 15 hours, run bi-yearly

Target candidates: Senior nurses and junior doctors in the Emergency Departments across the Severn Network.

For enquiries please contact: mttraining@nbt.nhs.uk

SMTN Medical Training

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European Trauma Course

The European trauma course is an internationally recognised trauma course covering the initial assessment and management of a major trauma patient. It is certified by the European Resuscitation Council. The course is a mix of workshops and scenarios course which is reflective of the European (including UK) approach to trauma in the hospital setting. This is a chargeable course – approx. £750 per attendee.

Duration: 2 ½ days, twice per year

Target candidates: Aimed at nurses and doctors who will be involved in the initial management and assessment of a major trauma patient. Usually band 6 and above nurses, or doctors ST3 and higher.

For enquiries please contact: ResuscitationTraining@nbt.nhs.uk

Trauma Team Leader

This annual regional update for Severn Major Trauma Network trauma team leaders (TTL’s) is a mandatory course for TTL’s. Attendance on at least 1 day every 3 years is required to remain on the rota. It consists of a series of lectures and wet lab dissections that focuses on recent changes in trauma practice and surgical skills required for rare events. These events include (but not restricted to) resuscitative thoracotomy, lateral canthotomy, emergency amputation and surgical airways.

Duration: 1 day, once per year

Target candidates: Trauma Team Leaders and aspiring Trauma Team Leaders who will are eligible to join the consortium or emergency department trauma team leader rotas. (Substantive Consultants in post within the trauma network, who have sufficient credibility in managing major trauma patients.)

For enquiries please contact: mttraining@nbt.nhs.uk

Emergency Anaesthesia in Major Trauma

This is a half day simulation course, aimed at those providing anaesthesia cover on the 3rd on-call rota covering major trauma calls and ED nurses. The purpose of the course is to provide an evidenced-based, standardised approach to emergency anaesthesia for major trauma. It focuses on utilising our Standard Operating Procedure for rapid sequence induction in trauma.

It aims to consolidate the experiences of trauma anaesthesia candidates have and provide exposure to the common emergencies and guidelines associated with anaesthesia for Major Trauma in the MTC.

Duration: ½ day, 3-4 times per year.

Target candidates: Those who will be delivering or assisting in the delivery of anaesthesia to major trauma patients in the emergency department. This includes senior nurses, trauma team leaders and senior trainees (ST3+) and consultants in anaesthesia and critical care. Places open to the network.

For enquiries please contact: mttraining@nbt.nhs.uk

Chest Drain

This course is a combination of workstations, and lectures specifically related to surgical intercostal chest drains in the context of major trauma. It covers indications, complications, technique for insertion and ongoing management of the drains. The last section looks at the indications for referral and the bespoke traumatic chest injury pathway including access to specialist thoracic services.

Duration: ½ day, 3 times per year (MTC). 1 session planned at YDH.

Target candidates: Those who may be expected to insert chest drains in trauma i.e. ST3 and higher specialist trainees in orthopaedic surgery, general surgery, anaesthetics/ intensive care, and emergency medicine. Places open to the network.

For enquiries please contact: mttraining@nbt.nhs.uk

Scribe Education Sim

Introduction to the role of the scribe & in-depth look at the documentation required.

Duration: ½ day as required for MTC or TU’s in the Severn Major Trauma Network

Target candidates: Emergency Department Band 3’s. Places open to the network.

For enquiries please contact: EDEducationTeam@nbt.nhs.uk

F1 & F2 trust-wide teaching

We provide training to F1 and F2 doctors trust wide as part of their weekly training programme. We focus on the primary survey, the assessment of the Major Trauma patient and procedures including transfusion, splints and binders and reduction of fractures.

Duration: 1 day

Target candidates: F1 and F2 Doctors

Junior Doctor Induction

We visit departmental induction to explain the role of the Trauma Team and the staff members within it. We also include dates for planned study days and M&M meetings. Currently attend Medicine, General Surgery, Neurosurgery and Orthopaedic induction sessions. We can tailor this training to meet the needs of your staff.

If you would like us to attend your induction, or arrange a specific teaching session, please get in touch.

Duration: 1 day

Target candidates: Junior Doctors

Development of a level 2 Emergency department Severn Network course

Adapted from the Musgrove Park hospital course. This is a comprehensive course mapped to the level 2 requirements in the NMTNG competencies. Would need to be PEER reviewed by the NMTNG once established and running.

Duration: 15 hours, run bi-yearly

Target candidates: Senior nurses and junior doctors in the Emergency Departments across the Severn Network.

For enquiries please contact: mttraining@nbt.nhs.uk

Trauma Team Members – currently on hold

This is a simulation based course looking at technical and non-technical skills for all members of the major trauma team. The aim of the course is to create an environment in which to practice trauma team skills, promote team working and to discuss any aspects of trauma team management.

Duration: 1 day, twice per year

Target candidates: All staff who will be attending trauma calls in the emergency departments.

For enquiries please contact: mttraining@nbt.nhs.uk

SMTN Conferences

Wide Off Off

Joint Peninsula and Severn Stakeholder Day, 10am-3pm, Tuesday 6th of May 2025

Submit a registration form

Location – Health Innovation South West, Vantage Point, Pynes hill, Exeter, EX2 5FD

Any queries for the Severn Major Trauma Network, please contact: MTTraining@nbt.nhs.uk

Agenda

TimeAgenda Item
09:30 - 10:00 Registration
10:00 - 10:15 Welcome - Dr Giles Haythornthwaite, pMTC Network Lead
10:15 - 10:55  WATCh Update and Future Directions - Dr Dora Wood, WATCh Clinical Lead
10:55 - 11:15Challenging case from a Trauma Unit Perspective - Dr Fionna Lowe, UH Plymouth Governance Lead
11:15 - 11:35Empowering Recovery: Enhancing Service Provision for Spinal Cord Injury - Amy Fraser, Paediatric Spinal Cord Injury Link Worker 
11:35 - 12:00Safeguarding in Focus: Latest Updates and Best Practices - Dr Will Christian, Consultant in Paediatric Emergency Medicine, Safeguarding Lead, Bristol
12:00 - 12:45Lunch
12:45 - 13:30Poly Trauma Case Study - Ms Flossie Carpenter, Paediatric T&O Reg Enhancing Paediatric Care: Service Provision at the pMTC - Miss Anna Clarke, Clinical Lead for Major Trauma
13:30 - 13:50Psychosocial clinical network guideline: Streamlining Network Guidelines through a platform - Nicky Robinson, pMTC Nurse Coordinator
13:50 - 14:10Coffee 
14:10 - 14:30Neurosurgical Time Critical Transfer Audit - Dr John Coveney, Specialist Registrar Paediatrics
14:30 - 14:55From Classroom to Clinic: Enhancing Nursing Education TU Visits - Jess Harvey, pMTC Nurse Coordinator 
14:55 - 15:00Review and Close - Dr Giles Haythornthwaite, pMTC Network Lead

Spinal Nursing Study Day, 08:30- 16:45 Tuesday 20th of May 2025

Registration link - Spinal Cord Injury Nursing Study Day Tickets, Tue 20 May 2025 at 08:30 | Eventbrite

Location - Salisbury & South Wilts Cricket Club, Wilton Road, Quidhampton SP2 9NY

Cost - £220

Time Agenda Item
08:45 – 09:00 Welcome, introductions, housekeeping and pre survey Spinal Education Lead Emma Gumbleton
09:00 – 10:00 Overview of spinal cord Injury Spinal Consultant Dr Gemma Simons
10:00 – 10:30 Spinal Outreach Services Acute Outreach and Admission Lead – Danilo Galila
10:30 – 11:00 Spasms and Spasticity Clinical Specialist Physiotherapist Racheal Coulson-Smith
11:00 – 11:15 Tea and coffee
11:15 – 12:00 Rehabilitation after spinal cord injury Clinical Specialist Physiotherapist Racheal Coulson-Smith
12:00 – 12:30 Management respiratory system Spinal Respiratory Nurse Specialist – Chelsie Hart
12:30 – 13:00 Autonomic Dysreflexia Spinal Education Lead – Emma Gumbleton
13:00 – 13:30 Lunch (provided)
13:30 – 14:00  Neurogenic Bowel Spinal Education Team – Harriet Evans
14:00 – 14:30 Neurogenic Bladder Spinal Education Team – Gemma Donaghy
14:30 – 15:00 Workshops – tea and coffee
15:00 – 15:30 Neurogenic Skin Spinal Education Lead – Emma Gumbleton
15:30 – 16:00 Psychological Support Lead Psychologist – Kath Gwynn
16:00 – 16:30 Spinal Outpatients Outpatient Lead/Clinical Nurse Specialist – Sen Peralta
16:30 – 16:45 Resources, questions and feedback

National Major Trauma Rehabilitation Group, 9-10th of June

Register via Eventbrite

Location – Birmingham Conference and Events Centre

Cost - £225

Dr Ankur Gupta-Wright - General Internal Medicine

Wide Off On A-Z of Consultants

GMC number: 6163885

Year & location of first qualification: 2007 Imperial College London

Specialty: Infectious Diseases & General Internal Medicine

Clinical interests: Tuberculosis, HIV, Tropical Medicine

Secretary: Denise Bennett/Lynne Brown

Secretary phone number: 0117 4146479

Dr Ankur Gupta-Wright is a consultant in Infectious Diseases and General Internal Medicine, actively involved in patient care, teaching and research. Dr Ankur Gupta-Wright undertook clinical and academic training in Leicester, Singapore and London, and have worked in many settings including low and middle-income countries. Dr Ankur Gupta-Wright's clinical interest are management of tuberculosis (TB), including drug-resistant TB, HIV, HIV and TB co-infection, tropical medicine and general infectious diseases. Dr Ankur Gupta-Wright's research interests are in how we can use point of care diagnostics to improve clinical outcomes in patients with suspected infections. Dr Ankur Gupta-Wright undertook a PhD in urine-based diagnostics for TB. Dr Ankur Gupta-Wright has Diplomas in Tropical Medicine & Hygiene, HIV medicine and Medical Leadership. Dr Ankur Gupta-Wright is a fellow of Advance HE and hold a Post Graduate Certificate in Learning & Teaching.

Gupta-Wright