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Friday, 19 May, 2000, 00:35 GMT 01:35 UK
Emergency care 'getting better'
Accident and emergency department
Seriously injured patients are now more likely to survive
The treatment of patients admitted to hospitals with serious injuries has improved significantly over the past decade, according to research.

However, the researchers warn that there is still room for improvement.

In 1988, the Royal College of Surgeons reported major deficiencies in trauma care in UK hospitals.

Dr Fiona Lecky and colleagues from the UK Trauma Audit and Research Network investigated whether and how that care has changed in the last decade. Their work is published in The Lancet medical journal.

They analysed the standard of treatment of more than 90,000 patients from data collected from almost half of the trauma units in England and Wales, and two in Northern Ireland.

In the majority of cases people get a very good service in this country, but we can always do better

Mr John Ryan, British Association of Accident and Emergency Medicine

The patients studied had sustained injuries that required immediate hospitalisation for at least three days; admission to an intensive-care or high-dependency unit; transfer between hospitals for more specialist care.

The chances that a patient would die as a result of their injuries declined gradually from 1989 onwards.

However, the proportion of patients who survived varied greatly between the best and worst units.

The time between the call to the emergency services and arrival at hospital increased from 32 minutes in 1989 to 45 minutes in 1997.

But the proportion of severely injured patients seen first by senior doctors increased from 32% to 60%.

Dr Lecky, the lead author on the report, said that A&E medicine was still a relatively young specialty, and had improved greatly since the 1960s and 1970s.

She said: "The improvements are due mainly to an increased training of staff and increased involvement of consultants in treating patients.

"Although serious trauma represents only about 0.1% of A&E work, it is a very important part."

'We could do better'

Mr John Ryan, is a member of the British Association of Accident and Emergency Medicine and an A&E consultant at the Royal Sussex County Hospital, Brighton.

He said: "In the majority of cases people get a very good service in this country, but we can always do better.

"What we do with the resources we have is highly efficient, but we are understaffed and could do better with more resources."

Mr Ryan said there were a number of factors which had resulted in better overall standards of trauma care:

  • better training of A&E doctors
  • more rapid access to diagnostic facilities
  • a recognition that patients do better when attended by trauma teams made up of a range of healthcare professionals

Mr Ryan said standards would rise still further with more resources, better training and the appointment of more senior doctors to positions "close to the front of the hospital".

He said standards varied because not all hospitals had easy access to specialist services, such as neurosurgery or cardiothoracic surgery.

In an accompanying commentary, Gregory Jurkovich from the University of Washington, Seattle, draws a parallel to similar improvements occurring in US trauma care.

He says that trauma-care systems take time to mature as staff gain more experience.

However, Mr Ryan said more resources were available to the US system, which tended to deal with a different type of trauma.

In the UK most injuries are what is classified as blunt trauma, for instance car accidents, or falling off roofs.

In the US doctors more often deal with penetrating trauma injuries such as gunshot or knife wounds.

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