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guidelines
trauma

A critical review of NICE Guideline 39—major trauma: assessment and initial management

02 May 2016
Features
02 May 2016
Volume 8 · Issue 5

Abstract

Major trauma is a leading cause of death in the under 40 years age group, and has a significant impact on morbidity, causing a financial burden to the National Health Service (National Audit Office, 2010). A recent guideline published by the National Institute for Health and Care Excellence (NICE, 2016a) seeks to address the recommendations made by a National Confidential Enquiry into Patient Outcome and Death (2007) and the National Audit Office (2010), therefore improving the standards of trauma care delivery across England.

This article critically appraises the recommendations made by NICE (2016a), while considering the available evidence and the implications on pre-hospital major trauma care.

In February 2016, the National Institute for Health and Care Excellence (NICE) published clinical guideline NG39, which focuses on the care of major trauma patients in England. The guideline provides recommendations for the initial assessment and management of major trauma patients in both the pre-hospital and in-hospital phase, and the flow of these patients through trauma networks. NG39 (NICE, 2016a) is supported by NG40: major trauma service delivery (NICE, 2016b) and a number of other specific guidelines on fracture management, complex fractures and the management of spinal injuries. This article focuses on reviewing and critical appraisal of the recommendations (Box 1) for pre-hospital care, the impact of these on the paramedic profession and ambulance services, and the future of major trauma care in England. It does not consider the specific care of burns patients, paediatrics or the elderly, as sub-sets of major trauma.

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NICE guidance
Major trauma
Paramedic
Pre-hospital care
Trauma network