Amol Chitre on Royal Preston Hospital as a Major Trauma Centre

15th October 2024

Mr Amol Chitre is the Clinical Major Trauma Lead for Royal Preston Hospital. In this blog, Amol discusses what happens at the Major Trauma Centre and the challenges of running it from the ageing Royal Preston Hospital site. Amol also explains how a brand-new hospital will benefit NHS colleagues as well as patients in the most critical need of care.

Tell us about your role

I’ve been working as the Clinical Major Trauma Lead in Preston for the best part of eight years now. Essentially my role is to make sure that we can deliver a high level of patient care, alongside implementing national guidelines into our hospital locally. I have to make sure that we have the resources and the allocations of personnel to try and meet the high standards. I also keep up to date on bringing in new ways of working, such as online services, to best serve the population who use our hospital services here in Preston.

What does a typical day look like in the Major Trauma Centre in Preston?

Major trauma is actually quite a small part of what we deliver as a hospital, and I’d estimate that less than 1 or 2% of A&E admissions are major trauma related.

Essentially, it is a network of services that is on sleep mode for the most part, but it has the ability to wake up very quickly to help patients in critical need.

For example, we might get a major trauma pre-alert from the ambulance service, in which case everyone is alerted, and the trauma response is initiated. This will then lead to getting a variety of different specialties and senior specialties attending in the Emergency Department (ED).

Typically you would have an ED, anaesthetics, orthopaedics, general surgery and Intensive Care Unit (ICU) neurosurgery. We also have the ability to call on specialties like vascular, plastic surgery, urology, ophthalmology, facial surgeons, Ear Nose and Throat (ENT) surgeons, and so on. This is what sets the Major Trauma Centre apart from other centres. It is the ability to be able to deliver lots of different specialties immediately on site. Everyone plays a part within the Major Trauma Centre, even if their specialism is called upon fairly rarely.

When that system is awoken, the process of managing the patient’s care springs to life, and things like theatres and interventional radiology may need to be involved, through to ward-based care and physiotherapy afterwards.

So it is truly a cross-specialty discipline, which can involve the whole hospital when it needs to.

What do you focus on in the Major Trauma Centre?

My day-to-day job is as an orthopaedic surgeon. So, for the most part, major trauma does not really affect me unless I am on call. In terms of the management elements, it is about troubleshooting if there is a problem, or if there is an escalation where my input is needed.

Generally speaking, it is more to do with organisation of resources and personnel. It is also about how we best meet local, national, regional guidelines, and often putting those guidelines together as well.

What does your response to patients with major trauma injuries look like?

Our response is very quick. If we get a pre-alert from the ambulance team, then you know roughly how long you have to assemble your team at the Major Trauma Centre. Where there is less warning, it is done on a “fast bleep” – we are ready to receive the patient within five minutes or so.

We work closely with the ambulance service to make sure that ambulances – including the the air ambulance – get patients to us in a timely manner, meaning we are able to deliver the right treatment as early as we can.

There is also coordination after patients have been discharged, working with trauma units around the network, with therapy teams within the hospital and within the network of rehabilitation facilities, such as the Walton Centre for head injuries. We also work with a number of charities as well, so we have very good relationships to support major trauma patients. It is not just for their medical injuries either, but also with things such as helping with finances or family relationships.

How would building a new hospital help with major trauma care?

The opportunity to build a new hospital that is truly bespoke for major trauma would be incredibly useful to us. One of the biggest issues that we have is that Royal Preston Hospital was mostly built around 40 years ago, and it slowly evolved into what it is today, rather than being custom built for what is needed now. Major Trauma Centres as a concept have only really been around for the last 10 to 15 years. And so, the ability to build a new hospital where all those services are co-located would help with so many things, such as having a smooth transition from the Emergency Department (ED) to scanners to theatres, and so on. We would also benefit from having a ward that is appropriately sized for the hospital.

Things would be far easier to manage, improving patient flow. We would still see patients continuing to access a high standard of care, but with much better efficiency, with much smoother transitions from one area to the next.