&lt;b&gt;Background and Aims:&lt;/b&gt; Trauma is still the leading cause of mortality in the first four decades of life.  Despite multiple reports on how trauma care could be improved in the UK, treatment has been shown to be inconsistent and of poor quality.  Trauma teams have been shown to have a positive effect on outcome.  We aimed to determine the prevalence of trauma teams in Scotland.  &lt;b&gt;Methods:&lt;/b&gt; We performed a telephone survey of 24 hospitals with Emergency Departments and spoke to the senior clinician regarding provision of trauma teams.  &lt;b&gt;Results:&lt;/b&gt;  5 (21%) of the hospitals questioned had trauma teams. The most common reasons for not having one were: no problem with current system 8 (44%) and inability to include senior enough staff on the team 6 (24%).  &lt;b&gt;Conclusions:&lt;/b&gt;  There are few trauma teams in Scottish acute hospitals.  There was little enthusiasm for introducing them for a variety of reasons.  Local evidence of benefit is likely needed before their adoption becomes widespread

Dignon, N.

Hornsby, J.

Puxty, A.

Quasim, T.

English

J. Hornsby

T. Quasim

N. Dignon

A. Puxty

Crossref

Provision of trauma teams in Scotland: a national survey

Enlighten

       Hornsby, J. and Quasim, T. and Dignon, N. and Puxty, A. (2010) Provision of trauma teams in Scotland: a national survey. Emergency Medical Journal, 27 (3). pp. 191-193. ISSN 1472-0205  http://eprints.gla.ac.uk/5279/  Deposited on: 06 May 2010   Enlighten – Research publications by members of the University of Glasgow http://eprints.gla.ac.uk PROVISION OF TRAUMA TEAMS IN SCOTLAND: A NATIONAL SURVEY   , Hornsby, James1, Quasim, Tara2, Dignon Neil3, Puxty Alex2  1. Specialty Trainee, Anaesthetics, Department of anaesthetics, Glasgow Royal Infirmary, Glasgow, Scotland 2. Specialist Registrar, Anaesthetics,  Department of anaesthetics, Glasgow Royal Infirmary, Glasgow, Scotland 3. Consultant Emergency Physician, Department of Emergency Medicine, Glasgow Royal Infirmary, Glasgow, Scotland   Corresponding author: A. Puxty, Department of anaesthetics, Glasgow Royal Infirmary, Alexandra Parade, Glasgow.  E-mail: apuxty@doctors.org.uk, 01412114621  The Corresponding Author has the right to grant on behalf of all authors and does grant on behalf of all authors, an exclusive licence (or non exclusive for government employees) on a worldwide basis to the BMJ Publishing Group Ltd to permit this article (if accepted) to be published in EMJ and any other BMJPGL products and sublicences such use and exploit all subsidiary rights, as set out in our licence (http://emj.bmjjournals.com/ifora/licenceform.dtl).  KEY WORDS   Patient Care Team Emergency Service, Hospital Trauma Centres Scotland Traumatology  WORD COUNT 1041 (excluding figures, tables, references and title page) ABSTRACT Background and Aims: Trauma is still the leading cause of mortality in the first four decades of life.  Despite multiple reports on how trauma care could be improved in the UK, treatment has been shown to be inconsistent and of poor quality.  Trauma teams have been shown to have a positive effect on outcome.  We aimed to determine the prevalence of trauma teams in Scotland.  Methods: We performed a telephone survey of 24 hospitals with Emergency Departments and spoke to the senior clinician regarding provision of trauma teams.  Results:  5 (21%) of the hospitals questioned had trauma teams. The most common reasons for not having one were: no problem with current system 8 (44%) and inability to include senior enough staff on the team 6 (24%).  Conclusions:  There are few trauma teams in Scottish acute hospitals.  There was little enthusiasm for introducing them for a variety of reasons.  Local evidence of benefit is likely needed before their adoption becomes widespread.    It has been estimated that there are between 10000-10600 trauma patients in the UK each year1 and their management has been shown to be inconsistent and of a variable quality2. Trauma remains the leading cause of death in the first four decades of life3,4 and has a high socioeconomic burden given that for each death there are 2 severely injured or permanently disabled trauma victims4.    Organised trauma centres have previously been shown to reduce trauma related mortality5-7 and the benefits of trauma teams are well described8,9. Reports from respected medical bodies (RCS, NCEPOD) called for a formal team to be available in all hospitals receiving major trauma. Scotland, however, has significant differences from the rest of the UK. Whilst most of the population live in urban conurbations, the remainder reside over a wide geographic area that is difficult to reach. This demographic has been shown to alter both the pattern of trauma injury and the times taken to travel to hospital10.   The aim of this survey was to determine the provision of trauma teams in Scottish hospitals receiving major trauma and the reasons for their absence, if any.     METHODS This audit did not require ethical approval. During March 2008, we contacted those hospitals with emergency medicine, anaesthesia, general surgery and orthopaedic surgery departments (n=24) that could receive major trauma. Each doctor was asked the questions detailed in the questionnaire (fig 1). Any answers which differed from the set responses were noted.   RESULTS In 21 out of 24 hospitals we spoke to an Emergency Medicine Consultant. In the remaining 3 departments the grade of seniority was a senior Specialist Registrar (n=1), a staff grade (n=1) and an SHO (n=1). The latter department is unique in that there is no permanent consultant emergency physician, however, its rural location necessitates receiving trauma from mountain rescue services.   Of the 24 hospitals contacted, only 5 (21%) had formalised trauma teams and these were in District General Hospitals. The team consisted of a middle grade or Consultant emergency physician, anaesthetic and orthopaedic registrars and 4 out of 5 teams included a general surgeon. Two had formal protocol driven criteria for paging the trauma team on arrival of the patient. One activated the team on the information given by, or at the request of, the Scottish Ambulance Service. The remainder left it to the discretion of the doctor dealing with the trauma. Four out of the five hospitals with trauma teams had a helipad. Nineteen (80%) acute hospitals did not have formal trauma teams. One hospital is planning to introduce a trauma team in the next year and whilst one hospital said it would ‘possibly’ introduce a trauma team in the next year, this was classified as a ‘No’ in the analysis. Eight of the nineteen hospitals (36%) felt that trauma teams were unnecessary as the emergency department staff could identify any staff that were needed and call them at the appropriate stage.    Six (24%) of the hospitals cited staffing problems as a reason for not having a formalised trauma team or felt that there would insufficient seniority in the teams to make them beneficial. One hospital had previously had such a trauma team but had to discontinue the team, as certain specialties would not reliably attend trauma calls. Results   n %What type of Hospital?     Teaching  7 29%  District General  17 71%       Do You Have A Helipad?     No   11 46%       Do you Have a Trauma Team?    Yes   5 21%   Do you criteria for calling?         Yes 2 40%     No 3 60%   Who Are On the Team?        A&E Middle Grade/Consultant? 5 100%     Anaesthetics  5 100%     Orthopaedics 5 100%     General Surgery 4 80%     Other (labs/x-ray) 1 20%        No   19 79%   Plan to Introduce in Next Year?         Yes 1 5%     No 18 95%   Reasons for not introducing a trauma team        Emergency department have no problems currently 8 44%      Speciality Rotas’ Unable to Support a Trauma Team 4 22%     Not Enough Staff 2 11%     Trauma By-Passes 2 11%     Lack of Support from Specialties 1 6%     Trauma Teams do not work 1 6% One hospital stated that trauma teams ‘do not work’. These results are shown across in table 1.  Figures 1 and two show pattern of trauma team provision and reasons for their absence, respectively (Table1: main results)           Figure 1. Provision of trauma teams.               Figure 2. Reasons for lack         of trauma team                                                           DISCUSSION Our Survey showed that few hospitals in Scotland have a formal trauma team with very few having plans to instigate them. Many hospitals felt their current system worked well and had no difficulties in contacting other acute specialities. The UK Trauma Audit and Research Network (UK TARN) data has shown, however, that median time to theatre was 161 minutes from emergency call and 115 minutes from arrival in the Emergency Department11.  A delay of over two hours is associated with increased mortality12 however trauma teams have been shown to reduce time to theatre13 and have mortality benefits8,9.    Ongoing blood loss14 and increasing time to laparotomy12 have been associated with increased mortality thus any trauma team must consist of personnel with the experience to be able to make quick and reliable decisions regarding theatre. In many hospitals it is this lack of senior personnel that is cited as a stumbling block to the introduction of trauma teams. This situation is likely to worsen given the introduction of the EWTD and Hospital at Night.   The presence of trauma teams in district general hospitals may result from their rural location and admission of more serious road traffic accidents10 or it may reflect smaller, more closely knit working relationships.  CONCLUSION The perception of the dubious validity of trauma teams as well as the difficulty in finding doctors of appropriate seniority to staff them suggests that any increase in the provision of trauma teams in Scotland is likely to be a slow process.  The prevalence of these teams will only increase if it becomes a government priority, there is local evidence to show improved outcome or there is economic benefit.        Competing interests: None declared Funding No funding was required for this study  REFERENCES  1. Better care of the Severely Injured.  A Joint Report from the Royal College of Surgeons of England and the British Orthopaedic Association.  July 2000 2. Anderson ID, Woodford M, Donbal FT, Irving M.  Retrospective study of 1000 deaths from injury in England and Wales.  BMJ 1989; 296: 1305-8 3. Lecky F, Woodford M, Yates D W:  Trends in trauma care in England and Wales 1989-97.  The Lancet 2000; 355:1771-75 4. Trauma, Who Cares?  A Report of the National Enquiry into Patient Outcome and Death. 2007 5. Nathens AB, Jurkovich GJ, Rivara FP, Maler, RV.  Effectiveness of State Trauma Systems in Reducing Injury Related Mortality: a National Evaluation.  J. Trauma 2000; 48(1): 25-33 6. MacKenzie EJ, Rivara FP, Jurkovich  J, Nathens AB, Avery B, Frey KP, Egleston BL, Salkever DS, Scharfstein DO.  A National Evaluation of the Effect of Trauma Center Care on Mortality. N Engl J Med 2006; 354(4): 366-78 7. Nathens AB, Avery B, Jurkovich GJ, Cummings P, Rivara FP, Maier RV. The Effect of Organized Systems of Trauma Care on Motor Vehicle Crash Mortality.  JAMA 2000; 283(15): 1990-94 8. Sakellariou A, McDonald PJ, Lane RHS, The Trauma Team Concept and its Implementation in a District General Hospital Ann. R Coll. Surg. Engl 1995; 77: 45-52 9. Petrie D, Lane P, Stewart TC. An Evaluation of Patient Outcomes comparing Trauma team activated versus trauma team not activated using TRISS Analysis.  Trauma and Injury Severity Score.  J. Trauma 1996; 41:870-3 10. McGuffie AC, Graham CA, Beard D, Wilkie SC.  Scottish Urban versus Rural Trauma Outcome Study.  J.Trauma 2005; 59(3): 632-8. 11. Henderson KIM, Coats TJ, Hassan TB, Brohi K.  Audit of time to Emergency Trauma Laparotomy.  Br J. Surg 2000; 87:472-76 12. Copes WS, Staz CF, Konvolinka CW, Sacco WJ, American College of Surgeons Audit Filters: Associations with Patient Outcome and resource Utilization. J. Trauma 1995; 38:432-8 13. Dodek P, Herrick R, Phang PT.  Initial management of trauma by a trauma team: effect on timeliness of care in a teaching hospital. American Journal of Medical Quality. 2000;15(1):3-8 14. Cayten CG, Stahl WM, Agarwal N, Murphy JG.  Analysis of preventable deaths b Mechanism of Injury among 13 500 Trauma Admissions.  Ann Surg 1991; 214: 510-20       APPENDIX 1-QUESTIONNAIRE  Questionnaire 1. What type of hospital are you? DGH / Teaching 2. Do you have a helipad? Yes / No 3. Do you have a trauma team? If yes (i) Who do you have on your team? a. A&E b. Anaesthetics c. Orthopaedics d. General Surgery e. Medicine f. Other (specify) (ii) Do you have a criterion for calling the team? (if so what?) If no (i) Do you plan to introduce one in the next year? (ii) If not then what is the reason for not having one? a. Not  necessary as current system adequate b. Lack of specialty support c. Do not believe in trauma teams d. Other (specify)             

American College of Surgeons Audit Filters: Associations with Patient Outcome and resource Utilization.

An Evaluation of Patient Outcomes comparing Trauma team activated versus trauma team not activated using TRISS Analysis. Trauma and Injury Severity Score.

Analysis of preventable deaths b Mechanism of Injury among 13 500 Trauma Admissions. Ann Surg 1991; 214: 510-20 APPENDIX

Audit of time to Emergency Trauma Laparotomy. Br J. Surg

Cares? A Report of the National Enquiry into Patient Outcome and Death.

Do you have a helipad? Yes /

Effectiveness of State Trauma Systems in Reducing Injury Related Mortality: a National Evaluation.

Initial management of trauma by a trauma team: effect on timeliness of care in a teaching hospital.

of the Severely Injured. A Joint Report from the Royal College of Surgeons of England and the British Orthopaedic Association.

Retrospective study of 1000 deaths from injury in England and Wales. BMJ

Scottish Urban versus Rural Trauma Outcome Study. J.Trauma

The Trauma Team Concept and its Implementation in a District General Hospital Ann.

W: Trends in trauma care in England and Wales 1989-97. The Lancet

What type of hospital are you?

Background and Aims: Trauma is still the leading cause of mortality in the first four decades of life.  Despite multiple reports on how trauma care could be improved in the UK, treatment has been shown to be inconsistent and of poor quality.  Trauma teams have been shown to have a positive effect on outcome.  We aimed to determine the prevalence of trauma teams in Scotland.  Methods: We performed a telephone survey of 24 hospitals with Emergency Departments and spoke to the senior clinician regarding provision of trauma teams.  Results:  5 (21%) of the hospitals questioned had trauma teams. The most common reasons for not having one were: no problem with current system 8 (44%) and inability to include senior enough staff on the team 6 (24%).  Conclusions:  There are few trauma teams in Scottish acute hospitals.  There was little enthusiasm for introducing them for a variety of reasons.  Local evidence of benefit is likely needed before their adoption becomes widespread

Enlighten: Publications

 
 
 
 
 
 
 
Hornsby, J. and Quasim, T. and Dignon, N. and Puxty, A. (2010) 
Provision of trauma teams in Scotland: a national survey. Emergency 
Medical Journal, 27 (3). pp. 191-193. ISSN 1472-0205 
 
http://eprints.gla.ac.uk/5279/ 
 
Deposited on: 06 May 2010 
 
 
Enlighten – Research publications by members of the University of Glasgow 
http://eprints.gla.ac.uk 
PROVISION OF TRAUMA TEAMS IN SCOTLAND: A NATIONAL SURVEY 
 
 , Hornsby, James1, Quasim, Tara2, Dignon Neil3, Puxty Alex2 
 
1. Specialty Trainee, Anaesthetics, Department of anaesthetics, Glasgow Royal 
Infirmary, Glasgow, Scotland 
2. Specialist Registrar, Anaesthetics,  Department of anaesthetics, Glasgow 
Royal Infirmary, Glasgow, Scotland 
3. Consultant Emergency Physician, Department of Emergency Medicine, 
Glasgow Royal Infirmary, Glasgow, Scotland 
 
 
Corresponding author: A. Puxty, Department of anaesthetics, Glasgow Royal 
Infirmary, Alexandra Parade, Glasgow.  E-mail: apuxty@doctors.org.uk, 
01412114621 
 
The Corresponding Author has the right to grant on behalf of all authors and does 
grant on behalf of all authors, an exclusive licence (or non exclusive for government 
employees) on a worldwide basis to the BMJ Publishing Group Ltd to permit this 
article (if accepted) to be published in EMJ and any other BMJPGL products and 
sublicences such use and exploit all subsidiary rights, as set out in our licence 
(http://emj.bmjjournals.com/ifora/licenceform.dtl). 
 
KEY WORDS  
 
Patient Care Team 
Emergency Service, Hospital 
Trauma Centres 
Scotland 
Traumatology 
 
WORD COUNT 
1041 (excluding figures, tables, references and title page) 
ABSTRACT 
Background and Aims: Trauma is still the leading cause of mortality in the first four 
decades of life.  Despite multiple reports on how trauma care could be improved in 
the UK, treatment has been shown to be inconsistent and of poor quality.  Trauma 
teams have been shown to have a positive effect on outcome.  We aimed to determine 
the prevalence of trauma teams in Scotland.  Methods: We performed a telephone 
survey of 24 hospitals with Emergency Departments and spoke to the senior clinician 
regarding provision of trauma teams.  Results:  5 (21%) of the hospitals questioned 
had trauma teams. The most common reasons for not having one were: no problem 
with current system 8 (44%) and inability to include senior enough staff on the team 6 
(24%).  Conclusions:  There are few trauma teams in Scottish acute hospitals.  There 
was little enthusiasm for introducing them for a variety of reasons.  Local evidence of 
benefit is likely needed before their adoption becomes widespread. 
 
  
It has been estimated that there are between 10000-10600 trauma patients in the UK 
each year1 and their management has been shown to be inconsistent and of a variable 
quality2. Trauma remains the leading cause of death in the first four decades of life3,4 
and has a high socioeconomic burden given that for each death there are 2 severely 
injured or permanently disabled trauma victims4.   
 
Organised trauma centres have previously been shown to reduce trauma related 
mortality5-7 and the benefits of trauma teams are well described8,9. Reports from 
respected medical bodies (RCS, NCEPOD) called for a formal team to be available in 
all hospitals receiving major trauma. Scotland, however, has significant differences 
from the rest of the UK. Whilst most of the population live in urban conurbations, the 
remainder reside over a wide geographic area that is difficult to reach. This 
demographic has been shown to alter both the pattern of trauma injury and the times 
taken to travel to hospital10.  
 
The aim of this survey was to determine the provision of trauma teams in Scottish 
hospitals receiving major trauma and the reasons for their absence, if any.  
 
 
 
METHODS 
This audit did not require ethical approval. During March 2008, we contacted those 
hospitals with emergency medicine, anaesthesia, general surgery and orthopaedic 
surgery departments (n=24) that could receive major trauma. Each doctor was asked 
the questions detailed in the questionnaire (fig 1). Any answers which differed from 
the set responses were noted.  
 
RESULTS 
In 21 out of 24 hospitals we spoke to an Emergency Medicine Consultant. In the 
remaining 3 departments the grade of seniority was a senior Specialist Registrar 
(n=1), a staff grade (n=1) and an SHO (n=1). The latter department is unique in that 
there is no permanent consultant emergency physician, however, its rural location 
necessitates receiving trauma from mountain rescue services.  
 
Of the 24 hospitals contacted, only 5 (21%) had formalised trauma teams and these 
were in District General Hospitals. The team consisted of a middle grade or 
Consultant emergency physician, anaesthetic and orthopaedic registrars and 4 out of 5 
teams included a general surgeon. Two had formal protocol driven criteria for paging 
the trauma team on arrival of the patient. One activated the team on the information 
given by, or at the request of, the Scottish Ambulance Service. The remainder left it to 
the discretion of the doctor dealing with the trauma. Four out of the five hospitals with 
trauma teams had a helipad. 
Nineteen (80%) acute hospitals did not have formal trauma teams. One hospital is 
planning to introduce a trauma team in the next year and whilst one hospital said it 
would ‘possibly’ introduce a trauma team in the next year, this was classified as a 
‘No’ in the analysis. Eight of the nineteen hospitals (36%) felt that trauma teams were 
unnecessary as the emergency department staff could identify any staff that were 
needed and call them at the appropriate stage.   
 
Six (24%) of the hospitals cited staffing problems as a reason for not having a 
formalised trauma team or felt that there would insufficient seniority in the teams to 
make them beneficial. One hospital had previously had such a trauma team but had to 
discontinue the team, as certain specialties would not reliably attend trauma calls. 
Results   n %
What type of Hospital?    
 Teaching  7 29% 
 District General  17 71% 
      
Do You Have A Helipad?    
 No   11 46% 
      
Do you Have a Trauma Team?   
 Yes   5 21% 
  Do you criteria for calling?     
    Yes 2 40% 
    No 3 60% 
  Who Are On the Team?    
    A&E Middle Grade/Consultant? 5 100% 
    Anaesthetics  5 100% 
    Orthopaedics 5 100% 
    General Surgery 4 80% 
    Other (labs/x-ray) 1 20% 
      
 No   19 79% 
  Plan to Introduce in Next Year?     
    Yes 1 5% 
    No 18 95% 
  Reasons for not introducing a trauma team    
    
Emergency department have no 
problems currently 8 44% 
    
 
Speciality Rotas’ Unable to 
Support a Trauma Team 4 22% 
    Not Enough Staff 2 11% 
    Trauma By-Passes 2 11% 
    Lack of Support from Specialties 1 6% 
    Trauma Teams do not work 1 6% 
One hospital stated 
that trauma teams 
‘do not work’. These 
results are shown 
across in table 1.  
Figures 1 and two 
show pattern of 
trauma team 
provision and 
reasons for their 
absence, respectively 
(Table1: main 
results) 
 
 
 
 
 
 
 
 
 
 
Figure 1. Provision of trauma teams.               Figure 2. Reasons for lack 
        of trauma team                                                
 
 
 
 
 
 
 
 
 
 
 DISCUSSION 
Our Survey showed that few hospitals in Scotland have a formal trauma team with 
very few having plans to instigate them. Many hospitals felt their current system 
worked well and had no difficulties in contacting other acute specialities. The UK 
Trauma Audit and Research Network (UK TARN) data has shown, however, that 
median time to theatre was 161 minutes from emergency call and 115 minutes from 
arrival in the Emergency Department11.  A delay of over two hours is associated with 
increased mortality12 however trauma teams have been shown to reduce time to 
theatre13 and have mortality benefits8,9.  
  
Ongoing blood loss14 and increasing time to laparotomy12 have been associated with 
increased mortality thus any trauma team must consist of personnel with the 
experience to be able to make quick and reliable decisions regarding theatre. In many 
hospitals it is this lack of senior personnel that is cited as a stumbling block to the 
introduction of trauma teams. This situation is likely to worsen given the introduction 
of the EWTD and Hospital at Night.  
 
The presence of trauma teams in district general hospitals may result from their rural 
location and admission of more serious road traffic accidents10 or it may reflect 
smaller, more closely knit working relationships. 
 
CONCLUSION 
The perception of the dubious validity of trauma teams as well as the difficulty in 
finding doctors of appropriate seniority to staff them suggests that any increase in the 
provision of trauma teams in Scotland is likely to be a slow process.  The prevalence 
of these teams will only increase if it becomes a government priority, there is local 
evidence to show improved outcome or there is economic benefit. 
 
 
 
 
 
 
 
Competing interests: 
None declared 
Funding 
No funding was required for this study 
 
REFERENCES 
 
1. Better care of the Severely Injured.  A Joint Report from the Royal College of 
Surgeons of England and the British Orthopaedic Association.  July 2000 
2. Anderson ID, Woodford M, Donbal FT, Irving M.  Retrospective study of 
1000 deaths from injury in England and Wales.  BMJ 1989; 296: 1305-8 
3. Lecky F, Woodford M, Yates D W:  Trends in trauma care in England and 
Wales 1989-97.  The Lancet 2000; 355:1771-75 
4. Trauma, Who Cares?  A Report of the National Enquiry into Patient Outcome 
and Death. 2007 
5. Nathens AB, Jurkovich GJ, Rivara FP, Maler, RV.  Effectiveness of State 
Trauma Systems in Reducing Injury Related Mortality: a National Evaluation.  
J. Trauma 2000; 48(1): 25-33 
6. MacKenzie EJ, Rivara FP, Jurkovich  J, Nathens AB, Avery B, Frey KP, 
Egleston BL, Salkever DS, Scharfstein DO.  A National Evaluation of the 
Effect of Trauma Center Care on Mortality. N Engl J Med 2006; 354(4): 366-
78 
7. Nathens AB, Avery B, Jurkovich GJ, Cummings P, Rivara FP, Maier RV. 
The Effect of Organized Systems of Trauma Care on Motor Vehicle Crash 
Mortality.  JAMA 2000; 283(15): 1990-94 
8. Sakellariou A, McDonald PJ, Lane RHS, The Trauma Team Concept and its 
Implementation in a District General Hospital Ann. R Coll. Surg. Engl 1995; 
77: 45-52 
9. Petrie D, Lane P, Stewart TC. An Evaluation of Patient Outcomes comparing 
Trauma team activated versus trauma team not activated using TRISS 
Analysis.  Trauma and Injury Severity Score.  J. Trauma 1996; 41:870-3 
10. McGuffie AC, Graham CA, Beard D, Wilkie SC.  Scottish Urban versus 
Rural Trauma Outcome Study.  J.Trauma 2005; 59(3): 632-8. 
11. Henderson KIM, Coats TJ, Hassan TB, Brohi K.  Audit of time to 
Emergency Trauma Laparotomy.  Br J. Surg 2000; 87:472-76 
12. Copes WS, Staz CF, Konvolinka CW, Sacco WJ, American College of 
Surgeons Audit Filters: Associations with Patient Outcome and resource 
Utilization. J. Trauma 1995; 38:432-8 
13. Dodek P, Herrick R, Phang PT.  Initial management of trauma by a trauma 
team: effect on timeliness of care in a teaching hospital. American Journal of 
Medical Quality. 2000;15(1):3-8 
14. Cayten CG, Stahl WM, Agarwal N, Murphy JG.  Analysis of preventable 
deaths b Mechanism of Injury among 13 500 Trauma Admissions.  Ann Surg 
1991; 214: 510-20 
 
 
 
 
 
 
APPENDIX 1-QUESTIONNAIRE 
 
Questionnaire 
1. What type of hospital are you? 
DGH / Teaching 
2. Do you have a helipad? 
Yes / No 
3. Do you have a trauma team? 
If yes 
(i) Who do you have on your 
team? 
a. A&E 
b. Anaesthetics 
c. Orthopaedics 
d. General Surgery 
e. Medicine 
f. Other (specify) 
(ii) Do you have a criterion for 
calling the team? (if so what?) 
If no 
(i) Do you plan to introduce one in 
the next year? 
(ii) If not then what is the reason for 
not having one? 
a. Not  necessary as current 
system adequate 
b. Lack of specialty support 
c. Do not believe in trauma 
teams 
d. Other (specify) 
 
 
 
 
 
 
 
 
 
 
 
 


Provision of trauma teams in Scotland: a national survey

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