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Informed consent may not be possible for many patients undergoing hip fracture and major trauma surgery, owing to delirium, dementia, altered conscious level, severe pain or the effects of sedative drugs. Patients should not be asked to sign a consent form if they do not have capacity to do so. Standard operating procedures must be compliant with the Mental Capacity...
Early communication with patients and their families is essential. On occasions, explanations and detailed discussion should be deferred or delegated to others, so that emergency treatment can proceed without delay.
When it is considered appropriate for a do not to attempt resuscitation in the event of a cardiopulmonary arrest (DNACPR) order, it should be discussed with capacitous patients, including those who have expressed their own wish not to be resuscitated.106,107 In patients not capacitous to consent, every attempt should be made to discuss this with next of...
A triage tool, similar to that developed by the American College of Surgeons, should be used to identify patients with suspected major trauma prehospital.35
Triage positive patients should be sent directly to an MTC if the travelling time is <60 minutes (or 45 minutes if agreed by the trauma network), unless there is an imperative to go to a closer TU for the immediate management of a life threatening condition.35
The separation of clinical and non-clinical recyclable waste should be considered.21
Triage positive patients should not be taken to a local emergency hospital (LEH), in other words an acute hospital not accredited as a TU or MTC.35
The majority of patients presenting to TUs with major trauma should be transferred to an MTC after immediate management by adopting a ‘Send and Call’ policy.63
The trauma team should attend in cases of suspected major trauma according to predefined local criteria. The trauma team should also be called out if there are unexpected findings after arrival in triage-negative patients, and to receive patients following interhospital transfer.
There should be a local protocol for immediate or emergency access to an operating theatre or intervention suite, with appropriately trained and experienced staff to provide rapid intervention in life threatening or limb threatening conditions.35
