Issue 3 July 2014 N o r t h W e s t C h i l d r e n s M a j o r Tr a u m a N e t w o r k N e w s l e t t e r Welcome to the Summer 2014 Edition of the North West Children s Major Trauma Network Newsletter. The newsletter s aim is to support professionals working with Children in the North West and North Wales to improve outcomes for all children who have experienced a Major Trauma. Special points of interest: Peer Review Number 2 - Page 1 National Peer Review Meeting - Page 2 Documentation during Reception and Resuscitation - Page 2 Trauma Unit Visits - Page 2 Accident Prevention - Page 3 Lithium Cell Batteries - Page 3 Children with ISS>9 admitted and retained - Page 4 Incident Report for 2013/14 - Page 4 Clinical Psychology Service for Children with Major Trauma - Page 5 Upcoming Events - Page 5 Useful Publications - Page 5 Members of the Team - Page 5 Déjà vu Peer Review Number 2! Following the first review of the Network in November 2013, the Network looked forward with eager anticipation to its second review on May 1st 2014. The second review took place due to the Major Trauma Review process being incorporated into the National Peer Review Programme of NHS England (which also undertakes the established national reviews of Cancer and Diabetes). The review consisted of submission of documentation, a self-assessment and a peer review site visit to Alder Hey Children s Hospital, with representatives from both RMCH and AHCH being present. The Review Team consisted of Professionals from the Midlands, Sheffield, Nottingham and the Review Support Team from London. Over 30 staff attended from across the Network thank you to everyone for supporting. The Network was assessed against 73 measures. Areas of good practice in our network included robust secondary transfer process, Major Trauma Simulations, Therapists energy and commitment, the work of the Trauma Cell, and the collaborative work between the two children s major trauma centres. Recommendations included that a MERIT service be fully commissioned, specific training in paediatric major trauma for paramedics, further engagement with Trauma Units, more robust surge planning. Within the ChMTC s recommendations were made about attendance at Damage Control Surgery training, and a clearer identification of lead consultant for continuing care of Major Trauma Cases after reception and resuscitation. Rehabilitation was also identified as an important issue including greater engagement of commissioners with this part of the pathway, transition into adult services and the development of a rehabilitation network. The peer review report is being circulated within the Network if you would like a summary of the review please email michael.wafer@cmft.nhs.uk 1
Page 2 Major Trauma National Peer Review Meeting Birmingham July 1-2 2014 The National Peer Review Programme Conference took place over 2 days at the Birmingham Hilton Hotel on the 1st and 2nd July. The conference was well attended with delegates from Major Trauma Networks all over England. The conference was led by Chris Moran National Clinical Lead and there were a variety of very useful presentations including best triage tools, 10 things to make a trauma team work and coordinating community and specialist rehabilitation. The meeting highlighted the continuing survival rates since the Major Trauma Centres and networks have been established.there was a special interest group on children's major trauma networks attended by representatives from Sheffield, Birmingham, RMCH, AHCH, TARN, South Tees and South Coast Ambulance Services. Areas discussed included dashboard indicators specific to children s major trauma, patient reported outcome measures, development of a national children s major trauma network, and identifying 3 key priorities for Major Trauma in Children nationally. Documentation during Reception and Resuscitation of Children s Major Trauma A documentation sheet has been produced by the Paediatric Emergency Department at RMCH to enable all of the key observations to be completed on one large sheet. This enables the Trauma Team to see an overview of all information e.g. observations, medications given whilst the child is being resuscitated. Once the documentation is complete each component part can be split into A4 size and placed in the notes. The sheet has proved especially helpful for the Trauma Team Leader and the person undertaking the scribe role and also helpful to ensure that all key data required for TARN is available in a central place. Further information on how the observation is used in practice is available from Lorcan Duane, Consultant PED, RMCH lorcan.duane@cmft.nhs.uk, details of how the sheet can be ordered michael.wafer@cmft.nhs.uk Trauma Unit Visits A number of routine Trauma Unit visits have taken place since the last newsletter by the clinical leads of the Network. In May 2014 a particularly helpful visit was when representatives of the Children s Network led by Bimal Mehta, Joint Clinical Lead visited the Isle of Man with a team from the Cheshire and Mersey Operational Delivery Network. The Isle of Man currently sees about 6,000 children per year in its ED department with children s Trauma being rare. The hospital faces unique challenges in the North West due to being dependant on air transfer to the ChMTC. A visit was also made to Ysbty Glan Clwyd issues discussed included cross border transport issues to Alder Hey. Trauma Unit/DGH visits in Greater Manchester included a well-attended meeting at Royal Bolton Hospital. Future visits are planned in the coming months to other Trauma Units and District General Hospitals. 2
Page 3 Accident Prevention The NWChMTN continues to make progress towards supporting the prevention of accidents in children. The Network Team had a very useful meeting with Katrina Phillips, Chief Executive of the Child Accident Prevention Trust, and the Network supported press releases to National and Local media for the Annual Child Safety Week in June. A good contact has also now been made with Public Health England Further information on the current work on accident prevention is available from Tracey Shackleton, Trauma Coordinator at Alder Hey Children s Hospital and Helen Blakesley Rehabilitation Coordinator. Two recent events took place to highlight accident prevention at Royal Manchester and Alder Hey Children s Hospitals (see left top picture Sam Jones, Garth Brindle (RMCH), Matt Dunn, Lisa Derbyshire (NWAS) at a week long event in the atrium area of RMCH during child accident prevention week. Also pictured (bottom picture) Tracey Shackleton, Liz Grady, Health Promotion Practitioner, AHCH and Emma Powell, Health Visitor, Bridgewater Trust at an event at Aintree Retail Park at which over 300 people were given information on accident prevention. Lithium Cell Batteries A key issue that has arisen in the accident prevention discussions has been a raised awareness of the dangers of ingestion of cell batteries by children. These small batteries are in many children s toys and present a serious risk to children. Sadly there have been some fatalities of children within the North West. Kate Parkins provided a very useful presentation at the Children's Major Trauma Governance Meeting in June. Kate has provided some advice for our newsletter please see below. Ingestion of Lithium button batteries should be considered if any history of difficulty swallowing, drooling, stridor, chest discomfort or choking, especially if the child is under 12 years old. It is advised that an x-ray is undertaken as soon as possible to locate a swallowed battery (including CXR, AXR & neck x-ray). If the battery is located in nose or ear, triage as an urgent review and remove as soon as possible after presentation as permanent injury i.e. destruction of nasal septum can occur. If a cell battery is located in the oesophagus it must be removed as soon as possible (even if asymptomatic)- serious burns can result within 2 hours. If the battery is located in the stomach, child asymptomatic, battery > 15 mm and child under 6 years, X-ray 4 days after ingestion (sooner if any symptoms). If still in the stomach remove endoscopically even if asymptomatic. If any symptoms, even minor remove battery from the stomach endoscopic ally. Further information available from NWTS team clinical lead Kate Parkins kate.parkins@nwts.nhs.uk 3
Page 4 Children with ISS>9 admitted and retained in Trauma Units and DGHs An audit has been undertaken of all children who had an ISS>9 recorded by TARN who were admitted and retained in Trauma Units and DGHs (i.e. not transferred on to the ChMTC s). A total of 120 children fell into this category ( April 2013 March 14) with 93% (n=115) being ISS 9-15 and 5= ISS>15. The most frequent injury being femoral fracture (see graph to left). Children cared for in the TUs/DGHs represent 32% of all children cared for in the Network with ISS>9, the remaining 68% being admitted and cared for at Alder Hey and Royal Manchester Children s Hospitals. The full report will be circulated and presented at the September NWChMTN Clinical Governance Meeting. Children s Major Trauma Network Incident Repor t for 2013/14 At the Governance meeting held in June a report was presented on incidents recorded in the ChMTC. A total of 35 Network related incidents were recorded from April 2013 to March 2014 the most common being transfer delays to the ChMTC. All incidents have been investigated. Causes of delay include Trauma Units/DGHs contacting the subspecialty rather than direct early one to one conversation between the Trauma Lead Consultant in the TU/DGH and ChMTC. The guidelines for transfer have been reissued and further work will be undertaken in the coming year for the Network to support reduction in transfer delays. 4
Page 5 Clinical Psychology Service for Children with Major Trauma This is a regional clinical psychology service covering the North West of England for children and young people who have sustained major trauma injuries, and who are being treated at the Royal Manchester and Alder Hey Children s Hospitals. The service offers assessment and management of the psychological needs of children, young people and their families, involving service users from the point of notification when children reach Intensive Care through to discharge planning, and where possible facilitating follow up of outstanding psychological needs in their local community. Where appropriate, the service also provides specialist assessments to children and adolescents who may present with neuropsychological difficulties. Typical referrals include support in relation to parental coping, concerns relating to neuropsychological functioning or developmental delay, anxiety in relation to treatment procedures, changes in emotional and/or behavioural functioning post-injury, or appearance-related concerns. The Clinical Psychologists work within and liaise closely with the wider major trauma multidisciplinary team. This service is led by Dr Stewart Rust, Consultant Clinical Psychologist in Neuropsychology at RMCH and Dr Vicky Gray at Alder Hey.( Further information Dr Sian Trenchard sian.trenchard@cmft.nhs.uk) Upcoming Events September 5th 2014 2pm: NWChMTN Governance Meeting Newton House, Birchwood October 6-7 2014: Definitive Surgical Trauma Skills Course: (Manchester) September 22-23 2014: Damage Control Orthopaedic Trauma Surgery London both events Royal College of Surgeons contact nbreckwoldt@rcseng.ac.uk November 21st 2014: 2nd Annual Conference for Major Trauma Nurse Coordinators at Southmead Hospital, Bristol: contact Lisa.Thomas@nbt.nhs.uk December 5th 2pm: NWChMTN Governance Meeting Newton House, Birchwood Useful Publications Ardolino A, et al (2014) The accuracy of existing pre hospital triage tools for injured children in England - an analysis using Emergency Department data. Emergency Medical Journal April 2014 Members of the Team Clinical Leads Naomi Davis Bimal Mehta naomi.davis@cmft.nhs.uk bimal.mehta@nhs.net Senior Management Leads Nicola Adamson Rachel Greer nicola.adamson@cmft.nhs.uk rachel.greer@alderhey.nhs.uk Network Manager Michael Wafer michael.wafer@cmft.nhs.uk Major Trauma Coordinator Samantha Jones Tracey Shackleton samantha.jones @cmft.nhs.uk tracey.shackleton@alderhey.nhs.uk Major Trauma Rehab Coordinators Helen Blakesley Sharon Charlton helen.blakesley@cmft.nhs.uk sharon.charlton@alderhey.nhs.uk TARN Support Debbie Crampton Mary Biggane deborah.crampton@cmft.nhs.uk mary.biggane @alderhey.nhs.uk Contributions to Future Editions This newsletter aims to be useful for all people involved in the care of children for any stage of the major trauma pathway. If you would like to contribute please do. For contributions or suggestions please email: michael.wafer@cmft.nhs.uk 5