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EDITORIALS: Nigel R M Tai, James M Ryan, and Adam J Brooks The neglect of trauma surgery BMJ 2006; 332: 805-806 [Full text]

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The neglect of trauma systems

Timothy C Lightfoot   (10 April 2006)

Training in trauma surgery- no room for complacency

BM Shrestha   (1 May 2006)

The neglect of trauma systems 10 April 2006
Timothy C Lightfoot, SHO Intensive care Broomfield Hospital, Chelmsford, Essex, CM7 7ET Send response to journal: Re: The neglect of trauma systems	The authors raise some very important issues regarding surgical trauma care in the UK [1]. However I feel the problem runs much deeper than this and within the organisation of trauma systems as a whole in this country. Since as early as 1988 it has been recognised that there are serious problems with the management of severely injured patients in the UK [2]. Our American colleagues have developed trauma centres hospitals graded on their ability to provide care for severely injured patients with level II + III centres feeding the more severely injured to a centrally located level I centre, capable of dealing with any multi-system trauma. A system proved to save lives [3,4]. However in the UK, largely for financial reasons we have not adopted this system. Instead we opt for a much more haphazard model [4]. Is it not time that we addressed this long overdue issue? I look forward to October 2007 and the findings of the NCEPOD (National Confidential Enquiry into Patient Outcome and Death) study of severely injured patients in the UK and its recommendations. I also look forward to a day when there is more interest from all specialties in Trauma in the UK. It is after all the leading killer of our younger generations and a disease process responsible significant national financial burden secondary to lost revenue, injury and medical cost (in 1997) valued as £7,970 for a minor injury, £102,880 for a major injury and £902,500 for a death [5]. References 1.Tai N. Ryan J. Brooks A. – The neglect of trauma surgery BMJ 2006;332:805-06 2.Report of the working party on the management of patients with major injury, Royal College of Surgeons of England, London 1988 3.Chaira O Cimbanissi S - Organized trauma care: does volume matter and do trauma centres save lives? Curr Opin Crit Care 2003; 9:510-4 4.Albert J. Phillips H. - Trauma care systems in the United Kingdom Injury 2003 Sep;34(9):728-34 5.Better care for the severely injured The Royal College of Surgeons of England and The British orthopaedic Association, 2000 www.boa.ac.uk Competing interests: Unpaid organiser of the annual trauma medicine for medical student’s conference in London
Training in trauma surgery- no room for complacency 1 May 2006
BM Shrestha, Consultant Surgeon Northern General Hospital, Sheffield, S5 7AU, UK Send response to journal: Re: Training in trauma surgery- no room for complacency	Dear Editor-I read with interest the editorial (Nigel RM Tai et al. BMJ 2006;332:805-6) and could not agree any more with their views that in the current system of surgical training in the United Kingdom, there is progressively decreasing exposure of the surgical trainees to the management of trauma patients and I am very concerned about their position when they assume responsibility of a consultant and get involved in decision-making process. The duration of training and the volume of work, both being compromised in the current system, has serious implications in terms of patient safety, with particular reference to the management of trauma patients, where an accurate and prompt management strategy needs to be adopted in order to achieve satisfactory outcome and to reduce morbidity and mortality. It can not be overemphasised that the value of clinical experience and sound judgement can not be replaced by the sophisticated investigations in acute trauma situations. At the same time, the experience gained through involvement in real scenario can not be substituted by learning through simulations, which is being increasingly used for teaching purposes. Gaining broad experience of managing all forms of trauma patients within a specified period of time is not impossible if a general surgical trainee is posted to an accident and emergency department towards their middle of the training period. It is prudent to appreciate the magnitude of this problem early and take measures before this becomes an unmanageable. The volume of trauma patients managed by individual hospital is variable and adequate exposure to any trainee within a specified time can not be guaranteed. In order to achieve the target, teaching hospitals should be identified, where trauma patients are managed in sufficient volume to provide reasonable experience to the trainees. If this objective is not achievable locally, in all honesty and the best interest of the patients, we should not feel ashamed to post trainees overseas in designated centres for a specified period where they can gain valuable experience within short space of time. Competing interests: None declared