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2021-22 Annual Report

Introduction by National Clinical Lead

Annual report time arrives once again, and in this new style of presentation my superlatives for the work of all who support the continued work, development and improvements of the Scottish Trauma Network will be brief. This is just as well, as the resources of my thesaurus begin to abate.

It is now 5 years since we convened and commenced our program of work to build and implement an entirely new clinical network of acute care and long-term rehabilitation for Scotland’s most seriously injured. August 30th 2021 witnessed the completion of Phase I with delivery of the fully operational end product. At time of writing, we run smoothly and successfully in the best traditions of “National Collaborative Pragmatism”.

All of this achieved of course, against the backdrop of complications presented to us by the pandemic. A remarkable achievement now recognised and acclaimed at the highest levels of the NHS, the Scottish Government, and national and international media.

This hard-earned and well-deserved reputation requires stiffening of the sinews and strengthening of resolve to be maintained, for us to progress further as we contribute well beyond our remit to the Remobilisation of the NHS in Scotland.

Thus, now begins Phase II, where we plan to tell the story using data, to raise standards for the future, and to demonstrate the sustained improved outcomes for patients, their families, their communities and the nation as a return on the visionary investment of these past 5 years.

The full report can be seen here

Martin McKechnie

National Clinical Lead

Scottish Trauma Network

STAG Annual Report

The eighth report by the Scottish Trauma Audit Group (STAG) since 2011 can be found on the Public Health Scotland website. Compliance with a subset of the Scottish Trauma Network Key Performance Indicators, case-mix adjusted mortality and Patient Reported Outcome Measures (PROMs) are within part one of the report. Part two and three provide a comprehensive summary of injuries and the patient journey for both adults and paediatrics respectively.

2020-21 Annual Report

Introduction from National Clinical Lead

2020 – 21 has been variously difficult, challenging, interesting and rewarding across the many spheres of activity, development and progress for the Scottish Trauma Network (STN). This Annual Report sits alongside and complements the imminent publication of the Scottish Trauma Audit Group’s (STAG) Annual Report for the same period. They both reveal and explore much of the data, operational and patient-centred clinical stories around this past year’s extraordinary activity within the Network. Set against the pandemic backdrop, the strong message coming from these reports is one of resilience, maintained high-quality patient care and an above-and-beyond spirit of collaboration and pragmatism on a national scale. That key performance and outcome measures have been delivered, yet alone maintained and improved in several areas, is worthy of acknowledgment and appreciation. The reports further explore much of our presentation and discussion at the Scottish Parliament Health and Sport Select Committee in January 2021.

There are many examples to celebrate, but I take this opportunity to highlight and express admiration and gratitude to the Scottish Ambulance Service, the ScotSTAR and EMRS transport and retrieval arms, and the newer Advanced Paramedics in Critical Care red teams therein. Their relentless and complex work in supporting and enabling the pandemic response across trauma and all related critical care services has been inspiring. The STN and patients are thankful to them beyond words. These thanks are expressed in equal measure to all staff and services recruited in good faith and optimism to the STN, yet who found themselves redeployed and reallocated to support the response in other vital areas such as Emergency Departments, Trauma Wards which became Covid High Dependency Units and Critical Care areas, and Theatres.

More interesting still is what much of this tells us about the improved access we now have to data and patient-reported measures. These are the mainstays of why the STN does what it does. With STN Trauma and STAG coordinators now embedded in our hospitals, we are able to reach more broadly across and deeper into the care of trauma patients than ever before. The resulting information and its analysis will further “tell the story” as we move beyond delivery of Phase I later this year, with the opening of the Major Trauma Centres at the Queen Elizabeth University Hospital in Glasgow, and the Royal Infirmary of Edinburgh, and the operational delivery of the Regional Networks in the West and South East of Scotland. These final pieces of the jigsaw will complete the national picture alongside the MTCs at Aberdeen Royal Infirmary and Ninewells Hospital in Dundee opened in 2018, supporting all the component services within our Regional Networks.

It is to be hoped that by the time of next year’s report we will be able to reflect upon a time of challenge and change with a more secure feel for what the immediate and medium-term future holds for our service. This learning allows us to reenergise and reconvene with strength, determination and the confidence that comes from surmounting such a significant hurdle.

Every person and every collaborative and linked service involved, described and embraced within the following pages is deserving of the greatest of gratitude and recognition. We are indebted to you all.

The full report can be seen here.

Martin McKechnie

National Clinical Lead

Scottish Trauma Network

Button Batteries and Magnets

 

This week is Child Safety Week hosted annually by the Child Accident Prevention Trust (CAPT) to raise awareness of preventable serious injury and death.

In our Paediatric working groups digestion of Button Batteries and Magnets are frequent topics with some parents unaware of the potential dangers. In the United Kingdom, clinicians have seen an increase of nearly double patients attending the Emergency Department with this injury.

Whys is swallowing button batteries and magnets so harmful?

Button Batteries 

Surprisingly, the harm is not usually caused by the chemicals leaking from the battery but due to the battery itself reacting with bodily fluids, such as mucus or salvia. This creates a circuit to release a substance like caustic soda, which is a strong alkali that can burn through tissue. Alkaline substances are on the opposite end of the pH scale to an acid but is still very dangerous. ‘Dead’ or ‘Flat’ batteries also have the potential to release the alkali so should be treated with the same caution.

BBC have released a video to highlight the risk of button batteries if they are digested:

Magnets 

If magnets are digested, they effectively burn holes in the intestines or bowels. The magnets stick together internally and through organs and tissues, and can cut off blood supply causing the tissue to die. Magnets are much more complex than button batteries to extract. The patient would need emergency surgery, then, depending on the severity of injuries, they may need numerous operations, bowel resection and time in intensive care.

The below picture from CAPT shows an x-ray from the case of a three-year-old swallowing small, round coloured magnets from a magnetic toy.

Image showing the disturbing trend in serious injuries from children swallowing small, round, coloured magnets from magnetic toys.

How to keep your children safe!

The British Association of Paediatric Surgeons have produced a set of questions to consider:

  • Where are they used in your home or childcare setting? Do you have any in your car? Knowing where and what they are in means you can use items with caution and remove if needed.
  • Are they installed securely? Are covers screwed tightly and even taped over? Avoiding Button Batteries all together is difficult but ensuring that when they are used they are installed correctly and covered up.
  • Where are they stored? Are they out of sight? Are they out of reach? Don’t leave them loose in a draw!
  • Dispose of them safely and immediately – even ‘dead’ or ‘flat’ batteries can cause significant injuries.

what are the symptoms after swallowing?

Button Batteries:

  • Excess Dribbling
  • Trouble Swallowing
  • Vomiting
  • Coughing
  • Choking
  • Unexplained chest infections

Magnets:

  • Abdominal pain
  • Fever
  • Nausea
  • Vomiting

IF YOU EXPECT YOUR CHILD HAS SWALLOWED A BUTTON BATTERY OR MAGNET, GO TO YOUR CLOSEST EMERGENCY DEPARTMENT AS SOON AS POSSIBLE. 

Many trusts, organisations have campaigned for the trading standards for magnets and button batteries to be changed, recently the standards had changed for button batteries.

Helpful Resources: 

The Royal College of Emergency Medicine: website

British Association of Paediatric Surgeons: website

Child Accident Prevention Trustwebsite

Healthcare Safety Investigation BranchFinal report – Healthcare Safety Investigation Branch (hsib.org.uk)

Building Safer CommunitiesBuilding Safer Communities (harmandinjuryhub.scot)

Keep Cycling!

While there are fewer other activities to divert us and our children during this period, it’s great to see everyone getting out on their bikes. It’s such a great way to get out and about and good for our general health and wellbeing. Safety equipment, such as helmets, can be helpful to keep their heads safe in case of a tumble, especially for children who are a bit less stable on their bikes. Mark Lilley, one of the Major Trauma Co-ordinators in Glasgow put together this short video with some advice when we had some glorious weather during lockdown last Spring/Summer. Keep cycling!

 

Image credit: Creative Commons, Pressedienst Fahrrad