Royal Preston Hospital’s role as a major trauma centre

Royal Preston Hospital is the major trauma centre for Lancashire and South Cumbria, providing support for adult patients across the area, as well as being part of the North West major trauma network for children. Emergency medicine consultant and co-lead for major trauma, Dr Kirsty Challen explains more about what this means for patients with serious and / or life-threatening injuries and how a new hospital on a new site to replace Royal Preston Hospital would benefit patients and staff.

What does your role at Lancashire Teaching Hospitals NHS Foundation Trust involve?

My role is emergency medicine consultant, both for adults and paediatrics. I am one of the clinical leads for major trauma for Lancashire Teaching Hospitals NHS Foundation Trust (opens in new window), focusing on receiving patients (assessment and initial investigations and tests to formulate a plan of care) and resuscitation. My co-lead for major trauma, Mr Amol Chitre, takes the lead on reconstruction and rehabilitation.

What is major trauma?

Major trauma is serious or multiple injuries that could be life-threatening or life-changing and usually caused by accident or violence. It may affect one or more parts of the body and involve one or more hospital specialities.

Some examples of major trauma include:

• high impact injuries from extreme sports
• injuries from falls down stairs (where even a shorter distance such as a slip down a couple of steps or from the equivalent of someone’s own height can cause major trauma in older, frailer patients) or longer falls
• injuries caused through high-speed road traffic collisions or where pedestrians have been hit by cars, such as abdominal injuries (liver, pelvis), rib cage injuries, chest wall injuries, lung injuries such as collapsed lungs, and brain injuries, and from assaults
• injuries caused by assaults.

What is a major trauma network?

A major trauma network is a group of service providers and personnel who serve a defined population and aim to reduce death and disability following life-threatening or life-changing injury. Each network is served by one or more major trauma centres, along with a number of trauma units within other local hospitals, and several pre-hospital care providers.

There is a Lancashire and South Cumbria-wide major trauma network for adults, with Royal Preston Hospital serving as the major trauma centre. Royal Preston Hospital sits within a bigger, North West-wide major trauma network for children, with Royal Manchester Children’s Hospital (opens in new window) and Alder Hey Children’s Hospital (opens in new window).

All providers that support patients with major trauma are involved, including those that provide pre-hospital care such as North West Ambulance Service NHS Trust (opens in new window), North West Air Ambulance Charity (opens in new window) and Great North Air Ambulance Service (opens in new window), and integrated groups of volunteer healthcare professionals who provide enhanced care at incident scenes, as well as local trauma units. In Lancashire and South Cumbria there are trauma units at Furness General Hospital, Royal Lancaster Infirmary, Royal Blackburn Hospital and Blackpool Victoria Hospital.

The aim is to get patients to the right place for their care at the right time, preferably first time, where people need specialist care for their injuries from the team of experts on hand in one location.

When and why did Royal Preston Hospital become the major trauma centre for Lancashire and South Cumbria?

Royal Preston Hospital became a major trauma centre for Lancashire and South Cumbria in July 2012. Since then, the major trauma centre has treated more than 11,500 trauma patients, many with life changing and life-threatening injuries. As the regional major trauma centre, Royal Preston Hospital receives the most severely injured patients from across Lancashire and South Cumbria and provides critical, life-saving treatment.

Royal Preston Hospital has all the necessary clinical specialities, services and departments to resuscitate and treat patients with serious traumatic injury, including access to the cardiothoracic service at Blackpool Victoria Hospital and regional burns centres.

Before a patient arrives at hospital, the role of emergency ambulance services is critical in the immediate treatment of the patient at scene, and the onward transfer of the patient to either one of the local treatment units or direct to the major trauma centre.

With 24/7 access to skilled specialists and emergency theatres, the major trauma centre at Royal Preston Hospital is able to provide emergency surgery, interventions and treatment to our most severely injured patients.

Although an adult-only major trauma centre, Royal Preston Hospital is capable of receiving and resuscitating children with major trauma injures that require stabilisation and onward transfer to one of the North West Children’s Major Trauma Centres at Alder Hey (Liverpool) and Royal Manchester Children’s Hospital.

Rehabilitation following major trauma starts as soon as the patient is physically and cognitively able to, and is managed collaboratively between the doctors, nurses, therapists (such as occupational therapy, physiotherapy, speech and language therapy) and healthcare teams, including voluntary organisations such as Headway (opens in new window) and psychology services, as required.

Who is treated as a major trauma patient?

1,014 people were treated for major trauma at Royal Preston Hospital during 2022

• 509 (50%) of these were aged over 65.

Major trauma patients arrived on site in a variety of different ways:

• 63 people were brought by helicopter
• 696 people were brought by ambulance
• 172 people were transferred from trauma units
• 83 people presented themselves.

The cause of their injuries was as follows:

• 498 had sustained low-level falls (two metres or less)
• 182 had fallen more than two metres (stairs, ladders and through roof usually)
• 259 were involved in road accidents.

As a result, 176 people were admitted to critical care.

Of the 1,014 major trauma patients, sadly 87 people died.

Major trauma patients came from across Lancashire and South Cumbria

• 556 from Preston postcodes (this includes Preston, Chorley and South Ribble)
• 143 from Blackburn postcodes
• 78 from Blackpool postcodes
• 78 from Lancaster postcodes
• 42 from Furness postcodes
• 11 from wider Cumbria postcodes (including people as far as Workington).

In addition, other patients came from Birmingham, Bradford, Bolton, Cambridge, North and South Wales, the Wirral, Essex, Kent, the Midlands, Cheshire, Scotland, the North East, the South West, Hertfordshire, Yorkshire, Manchester and Oldham.

What does having a major trauma centre at Royal Preston Hospital mean for patients in Lancashire and South Cumbria?

If you have severe injury, you could have a greater chance of surviving. A major trauma centre brings together different specialists involved in your care in one place.

Patients can benefit from being with and talking to other patients who have experienced a major trauma. Staff can also benefit from working with other staff with experience of major trauma care – both from a learning and development perspective and for moral support.

Royal Preston Hospital already had specialist expertise in place when the major trauma centre was initially established and Lancashire Teaching Hospitals have continued to build on that, with expertise at the front door in emergency medicine and anaesthetics. Also, emergency department and critical care staff are involved in pre-hospital care on the helicopters with the air ambulance teams, which helps to develop relationships and understanding across departments. This makes the patient experience as smooth as it can be in difficult circumstances.

If a patient has multiple issues involving different specialist departments, then having all the experts together makes for much more holistic thinking about a patient’s treatment plan.

How would having a new hospital on a new location benefit patients and colleagues?

The current layout makes things harder than they should be. For example, if we have two very sick patients at once, one of them has to be pushed past the end of the other patient’s bed to get to the scanner. If you have a very distressed patient, then the patient next door is able to hear them. Departments required by major trauma patients are not all located close enough together, resulting in patients being transported longer than ideal distances along corridors and in lifts. For example, if we need a specialist opinion from vascular and someone is unwell on the ward block, then it is three or four floors down, which is not ideal for transporting a very sick patient.

The current Royal Preston Hospital is starting to show its age now. In the most case, it was designed for the population demographic at the time in the 1970s. We do not have enough side rooms and there is not enough flexibility in the emergency department. It is now too small for what we do, despite expanding where we have been able to over time by pinching bits of next-door departments.

A purpose-built construction designed for use with current and future care needs, with good transport links and which does not disrupt local residents with helicopters and ambulances arriving and resulting traffic, would be a huge benefit to the local community. The current facilities and their challenges can make it dispiriting to be cared for in and to work in Royal Preston Hospital.

A new hospital, designed to modern standards, would improve patient experience and be a nicer place to be for both patients and staff.