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Prehospital craniotomy coming to a trauma system near you? https://t.co/ZpS1MMUa2y

@michaelpsenger You mean "release the data" besides the literally hundreds of papers that have been published on covid outcomes?

https://t.co/sHcORTuzsg

I'd try it too - but regret it

Looking forward to the @USC Annual Trauma Symposium this Thursday and Friday. Register for in-person or virtual attendance: https://t.co/CbRZkHRDp2

@TomVargheseJr @JBMatthews @SWexner @SurgJournal It’s probably at least a 2:1 ratio of careers ended vs careers made by SoMe

@1bitcoinmatters @ConceptualJames Mao, is that you??

@Dr_Claire_B @clifford0584 @DrPhilipBraude @jim_crawfurd I am not saying that this best care happens everywhere now. But if we truly want an equitable, high quality, resource effective trauma system that works for all members of the population, we need to fully value, fund and upskill our trauma units.

@Dr_Claire_B @clifford0584 @DrPhilipBraude @jim_crawfurd Perhaps. But there are very good reasons why it would be beneficial to operate on a 20 year old with a complex pelvic fracture and to manage a frail 80 year old conservatively. And in that case combined orthogeriatric care in a TU would, hopefully, be entirely appropriate.

@DrPhilipBraude @Dr_Claire_B @jim_crawfurd Well, the absolutely most complex should be in the MTC. But elderly trauma is everywhere. There are excellent geriatricians, rehab professionals in TUs. Overall clinical pathway and experience can be as good and perhaps better in a TU.

@jim_crawfurd @DrPhilipBraude @clifford0584 @DrRJWebb I think the real issue is where does an individual focus their efforts in terms of training & development? If trauma care in a TU is not recognised and resourced, then it falls down the list of competing priorities. This is where we need to turn attention and funding to TUs.

@jim_crawfurd @DrPhilipBraude @clifford0584 @DrRJWebb We're not paid to be happy (sadly!). We're here to be competent within the field of expertise that we trained for. All of these conditions fit within the relevant specialties' curricula. But MTCs, networks and national bodies need to support this through continued education,

@DrPhilipBraude Yes. It's very much in development so not ready for prime time sharing. Might (might) talk about it a bit at the National Trauma meeting on 6th June. But only have 10 mins! :) We're working it up for London region atm and trying to socialise/gain traction with the ICBs.

@jim_crawfurd @DrPhilipBraude Yep and there's a noticeable difference in TUs close to and distant from MTCs in terms of what they see and how/where ongoing care is provided. Again probably wholly appropriate.

@jim_crawfurd @DrPhilipBraude Yep. And thats where MTC support should kick in... Before for training/education, during for decision making, after for case review/QI

@DrPamChrispin @jim_crawfurd @DrPhilipBraude Yes. Most TUs would not need a huge amount of increased resource to make this possible though. But they definitely need some. This would not only improve quality, outcpmes and experience, but also reduce complications and improve flow, freeing up beds for elective care.

@jim_crawfurd @DrRJWebb @clifford0584 @DrPhilipBraude Yes totally. But I think its cultural because of the way TUs have evolved (or not) rather than a fundamental inability to manage these patients. Something that can and should be addressed given that they are looking after most of these patients.

@jim_crawfurd @DrPhilipBraude But most of the injuries they would be dealing with are neither rare nor difficult. Pneumothorax, simple rib fractures, non-op liver injury, mild head trauma, isolated stable TL spine #s, isolated long bone #s. Otherwise it's not a trauma unit but a local emergency hospital.

@DrPhilipBraude The "trauma" in trauma units has been grossly undervalued, principally by the commissioning structure, but also the early narrative. 50% of severely injured patients in London are wholly managed in TUs. We're working to develop a new trauma system structure to recognise this.

@DrPhilipBraude Structural as in you don't need specific infrastructure/service reconfiguration to provide good quality care. Eg you don't per se need specific equipment to deliver high quality older patient care. You need the people, education, dedicated time etc. Quality should be everywhere