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Trauma care crisis

10th April 2006

10042006_traumabed1.jpgDoctors in this week’s BMJ say that delivery of trauma care in Britain is threatened by a lack of training opportunities and a dedicated service infrastructure within the NHS.

The UK lacks training opportunities for trauma surgery and a service infrastructure, problems that other countries have recognised and started to remedy, write Professor James Ryan and colleagues. James Ryan is Leonard Cheshire Professor of Conflict Recovery and Honorary Consultant in Emergency Medicine, University College Hospital, London. The management of severely injured patients is particularly demanding because trauma does not respect the boundaries of anatomy or surgical specialty, they say.

The absence of a dedicated trauma service infrastructure within the NHS has hampered efforts to improve training, while demands from surgical institutions for a national framework for trauma management and centralisation of expertise have not been heeded.

Trauma doctors in North America enjoy dedicated training programmes and recognition of their discipline, while, in Britain, trauma has never been recognised as a separate surgical specialty.

They warn that the general surgeon’s role as provider of holistic trauma care risks being fatally eroded whilst younger specialties such as emergency medicine, and critical care establish ever-expanding fields of responsibility.

They believe that the UK’s surgical institutions should fundamentally re-examine the issue of trauma training for surgeons. They say that in particular, Britain needs a robust way of identifying, training, and accrediting a cadre of surgeons with the potential to become clinical champions of trauma services.

They write that “Sanctioning the birth of acute care surgery as a discrete discipline could provide a training path and career structure for trauma surgeons?. They conclude that “more importantly, such a development may encourage a retooling of provision in a health service that has so far escaped all efforts to systemise the care of the seriously injured.?

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