1. 1999-2000 Report of the Working Party on the Management of Patients with Head Injuries 1999

2. 2007

3. 2008

4. 2009

5. 2009

6. ? 2010

7. MAJOR TRAUMA IMPROVEMENT SUMMIT improving treatment and rehabilitation for major trauma patients May 2010

11. Stoke-on-Trent Birmingham Coventry 60 miles

12. 60 miles 45 minutes by land ambulance 45 minutes by helicopter Stoke-on-Trent Birmingham Coventry

13. ACS 2006 Physiology Anatomy Mechanism Special features

14. Accuracy of ACS Triage Criteria

15. Acute Care and Surgery Trauma Team and activation Trauma Team Leader Emergency Radiology Emergency Surgery Clinical Advisory Group Recommendations to the Department of Health

16. Care should be led by consultants experienced in major trauma Major trauma is most likely to occur at night-time or at weekends National Audit Office 2010

22. Ongoing Care and Reconstruction Patient-centred care Dedicated trauma wards and theatres Intensive care Repatriation Clinical Advisory Group Recommendations to the Department of Health

23. Head Injury ‘Scandal’ 1 Time to decompression

24. Mendelow AD, et al . Extradural haematoma: effect of delayed treatment. British Medical Journal 1979; 1 :1240-1241 Acute extradural haematomas have a better outcome if evacuated promptly A delay of more than 2 hours from clinical deterioration to haematoma evacuation led to significantly worse outcome

25. Leach P, et al. Transfer times for patients with extradural and subdural haematomas to neurosurgery in Greater Manchester British Journal of Neurosurgery 2007; 21 :11-15 * Mendelow 1979 ** Seelig 1981 59.0% (59*) GOS 5 (good recovery)‏ 7.2% 7.7% GOS 2 & 3 (PVS or severe disability)‏ 54.8% (34**) 23.1% GOS 4 (moderate disability)‏ 38.1% (57**) 10.3% (17*) GOS 1 (death)‏ 6.0 h 5.25 h Overall transfer time 0.75 h 0.75 h Arrival to surgery 2.38 h 2.5 h CT to arrival 2.25 h 2.0 h Deterioration or injury to CT 42 39 Number of patients Acute Subdural Haematoma Acute Extradural Haematoma

26. Sergides IG, et al. Is the recommended target of 4 hours from head injury to emergency craniotomy achievable? British Journal of Neurosurgery 2006; 20 :301-305 Number of patients 23 Isolated extradural 9 Mixed extradural and subdural 1 Isolated subdural 7 Intracerebral 4 Mixed subdural and intracerebral 2 Number operated < 4 hours of injury 0 GOS 1 (death) 21.7% GOS 2 & 3 (PVS or severe disability) 13.0% GOS 4 (moderate disability) 21.7% GOS 5 (good recovery) 43.5%

27. Head Injury ‘Scandal’ 2 Refusing non-operable cases

30. Head Injury ‘Scandal’ 3 Inappropriate repatriation

32. Rehabilitation Early start Director of Rehabilitation Coordination Country-wide review Clinical Advisory Group Recommendations to the Department of Health

34. Journal of Rehabilitation Medicine 2010; 42 :(in press)

37. The costs of major trauma are not fully understood, and there is no national tariff to underpin the commissioning of services Funding arrangements do not reflect the true costs National Audit Office 2010

38. HRG Grid for Major Trauma Professor Keith Willett (in development)

39. Network Organisation Definitions and designation Boundaries based on needs Responsibility for transfer TARN mandatory Performance framework Clinical Advisory Group Recommendations to the Department of Health

40. By September 2011: TARN Compliance Primary care trusts should use their commissioning powers to require all acute and foundations trusts with emergency departments that receive trauma patients to submit data to TARN National Audit Office 2010

45. Avery B. Nathens; Gregory J. Jurkovich; Ronald V. Maier; et al. Relationship Between Trauma Center Volume and Outcomes JAMA. 2001;285(9):1164-1171

46. Penetrating Abdominal Injury Multisystem Blunt Trauma