The London Regional Major Trauma System: A Literature Review of Epidemiology and Current and Future Challenges.

Trauma has been one of the world's most common causes of death among younger age groups. In the UK, a lack of an organized and streamlined approach was reported in the management of traumatic injuries and patients involved in trauma cases in the UK. Therefore, a major trauma network system was devised to address these issues in line with other trauma systems around the world. This was followed by the establishment of the London trauma network with four major trauma centers (MTCs) spread across the London region, with each of these MTCs connected to a group of smaller hospitals called trauma units (TUs). The functioning of all these MTCs is governed by national standards. A trauma system involves an inclusive network of trauma care providers. This network includes pre-hospital care services, hospitals receiving acute trauma admissions, and post-hospital rehabilitation services working in close coordination with social care services and community services to achieve optimal use of these resources to deliver the correct treatment at the correct time by specialist MTCs. Specifically designed major trauma triage tools are used by the prehospital teams to identify severely injured patients, and those who have been identified as triage-positive patients are airlifted and transferred by air ambulances to the MTCs within 60 minutes. For instance, the Royal London Hospital's Helicopter Emergency Medical Service (HEMS) is the pride of London's trauma network system and plays an important role in reducing the transfer time. First, MTCs are expected to handle massive volumes of trauma, and they are constantly under pressure to meet national standards. Therefore, it becomes necessary for the smaller TU hospitals to ensure the patients who are to be transferred have adequately undergone triage through established specific local triage protocols, which could, however, result in under-triage errors because of misjudgment of major injuries as minor injuries, which subsequently get less priority while managing minor trauma. Second, the changing landscape of surgical training with increasing demands and pressure on the system has put the trainees in a dilemma about the sustainability of the current training curriculum. Emphasis should be given to simulation-based training, which could address the issues of reduced theater time and could work as a good alternative, both for learning and teaching. Third, the lack of self-directed therapy that is tailored to meet a patient's demands has resulted in a disorganized delivery of rehabilitation services for patients suffering from polytrauma. However, like any system trying to make a paradigm shift, having pros and certain distinctive characteristics, the trauma system also has certain deficits, which, when appropriately addressed, as mentioned earlier, may ensure smoother functioning of the trauma system.