Incidences of major trauma are fortunately very rare, but vehicle accidents make up a significant part of these. When they do happen, it is essential that all the professionals involved work together seamlessly to provide the most effective interventions. Information from major trauma units also provide valuable information to support local accident prevention.

There are 16 Major Trauma Centres that accept child Major Trauma in England. The North West Children’s Major Trauma Network, co-ordinated from Manchester Children’s Hospital and Alder Hey Children’s Hospital, is the only children’s major trauma network in the country. The service supports the care of children from the time of the injury through to admission, care in the hospital, rehabilitation and discharge.

Managing the network

Mike Wafer is the Major Trauma and Paediatric Critical Care Network Manager, based at Royal Manchester Children’s Hospital and Alder Hey Children’s Hospital Liverpool. Mike, whose background is in nursing and NHS management, is responsible for overseeing the smooth running of the network, ensuring that there are protocols in place to enable professionals and services to coordinate as effectively as possibly, and ensuring the dissemination of information to support accident prevention.

What is Major Trauma?

Mike explains that, fortunately Major Trauma is a rare event, and:

‘With the carefully coordinated services and expert professionals provided by Trauma Networks, mortality is low once admitted to hospital.’

A data sample from 2015-2019 showed that 638 children, under, 16 were admitted to the North West Children’s Major Trauma service during this period.

Major Trauma can be defined as any injury that has the potential to cause prolonged disability of death. It is determined by an Injury Severity Score (9 and above is classified as Major Trauma, 15 and above is classified as Severe Major Trauma). 

Mike says that:

‘Major Trauma is not always evident initially, for example handlebar injuries from bikes can cause serious injuries but the child may not immediately appear to be seriously injured.’

What causes Major Trauma?

With children, accidents involving vehicles is one of the top two causes of major trauma - 34 per cent. Falls are the other major cause, including falls from low heights, falls from a height, and non-accidental injuries.

Determining major trauma

Major Trauma, Mike explains, is determined and managed in the following way:

  • A triage tool at the roadside used by ambulance staff who attend the accident
  • Support by a Trauma Cell based in the ambulance’s service which gives advice to paramedics at scene

If the accident is within one hour of travel, then anyone classified as suffering major trauma will be taken directly to a Major Trauma Centre.

‘In some cases the person will be resuscitated on the roadside and then taken by ambulance to their local hospital if there is an immediate risk to the child, and then transferred to the Major trauma Centre where the expertise is available,’ Mike says.

Major trauma accidents involving vehicles

Out of the 638 children treated by North West Children’s Major Trauma between 2015-2019, 121 of these were child pedestrians hit by a vehicle, and 82 of these were children involved in bicycle injuries (with no other vehicle involved).

Examples of incidents involving vehicles and children:

Examples of major trauma incidents involving vehicles, handled by the North West Network, include: a van backing into a toddler and then dragging the child a short distance; a four-year old running out between cars into the path of a car doing 30mph; a five-year old getting out of their family car on the hard shoulder of the motorway and being hit by a car driving at 70 mph; an 11-year old sustaining head injuries after being hit by a bus, doing 25mph; and a 14 year old playing ‘chicken’, who was hit by a car doing 60 mph.

Examples of child cyclists hit by vehicles

For examples of the accidents where children on bikes were hit by other vehicles, Mike gives the following examples: An 11-year old cyclist hitting a windscreen and experiencing traumatic brain injury, including bleeding within the brain; a 14-year old cyclist hit by a truck; and a 13-year old falling off while riding a bike downhill and receiving a serious head injury. (None of these children were wearing cycle helmets.

Examples of incidents involving child cyclists and no other vehicle:

Examples of child cyclists who have been seen by the North West Children’s Major Trauma Service include: a six year old falling from their parent’s bike, when not wearing a helmet; a six year old falling from a bike and hitting their genitalia on the wheel; an 11 year old doing stunts on a bicycle and the handlebars going into their abdomen; and a 14 year old riding downhill on a bike and hitting a metal barrier.   

Importance of data collection to promote road safety

All hospitals in the country who have an emergency department input their data into the TARN data base – The Trauma Audit &Research Network, which is based in Salford.

TARN is a national community of health professionals with a shared language on Major Trauma. It includes detailed demographics, descriptions of types of injury and treatment.

Examples of partnership working in the North West

The North West Children’s Trauma Network has been involved in the following joint initiatives:

  • The 999 Day at the Trafford Centre is a joint partnership between Health and Emergency Services Trafford, Manchester, to create greater safety awareness among large groups of children.
  • Alder Hey’s five-year retrospective audit of patients admitted with head injury following a road accident.
  • A joint initiative with Safety Central, managed by Cheshire Fire Service, to bring together stakeholders across the North West to identify a strategy for focusing on target areas for preventing child major trauma.
  • A meeting held by the Greater Manchester Academic Centre for Acute Tissue Injury and Trauma Care invited the Network to give a presentation on the prevention of children’s major trauma.
  • The After Trauma Day, hosted by Safety Central, brings together children who have survived major trauma and their families, and creates greater awareness about major areas of safety.

Key points:

  • Major Trauma Systems have a rich source of data on accidents on the road with the most severe consequences.
  • Accidents on the road are of different types and it may be useful to categorise them by mechanism, type of injury, age etc to target interventions to inform prevention practice
  • Major Trauma Centres have, as a new standard, that they are involved in prevention of Major Trauma initiatives.
  • There is a nationwide network of Major Trauma Centres which meet regularly including a national group for children – one of the priorities for that group being to support prevention of major trauma.