Injury or trauma is one of the leading causes of death and disability in the Republic of Ireland (as it is all over the world) but it has remained relatively neglected as a subject of medical or surgical research in this country. Moreover, it is widely recognised that medical training here in the care of severely injured patients is also deficient. Such relative neglect and deficiency have become increasingly problematic in Irish healthcare and have been highlighted in recent years as the profile of both unintentional and intentional injury has grown. Recently, for example, popular dismay has been expressed at the disturbing number of deaths and injuries caused by road traffic collisions on Ireland’s roads. Industrial action over the past few years has also drawn attention to the daunting scale of accidental injury and death associated with the construction industry. Additionally, gun-related and other gangland violence in the Republic has escalated dramatically. The Royal College of Surgeons in Ireland, with others, has carefully considered the issue of trauma care and for over a decade has been instrumental in enhancing the training of surgeons in initial care of the injured through, for instance, the globally recognised Advanced Trauma Life Support [ATLS] and the Care of the Critically Injured Surgical Patient [CCrISP] training courses. It has also sought to encourage debate through colloquia and journals. In its determination to improve the quality of care provided within the Irish healthcare setting, the College has concluded that a clear set of Clinical Guidelines should be issued for those dealing with severely injured patients, particularly those who may have little experience of major trauma cases. These guidelines deliberately concentrate on the initial care of severely injured patients as this is the area where experience has shown both the greatest deficiency and the greatest opportunity in trauma care. Where possible, the guidelines have been referenced with an emphasis on evidence-based medicine and/or authoritative sourcing (e.g. the Trauma Committee of the American College of Surgeons). The additional aims of this document are to explain the rationale behind the development of the guidelines, to briefly outline the College’s aspirations for trauma care in Ireland over the coming decade and to provide for quick reference (in the appendices) advice with regard to certain troublesome aspects of trauma care (such as prevention of transmissible infections or management of haemorrhage in those who may decline blood transfusion). A limited but wideranging further reading section is also included for those who wish to advance their understanding of recent developments in trauma care both in this country and abroad. Finally, it is recognised that healthcare throughout Ireland has a proud tradition of local innovation, great dedication and often heroic work by surgeons and their many colleagues. This document has been compiled with those factors clearly in mind. It is hoped that the guidelines, accompanying recommendations and references will be of practical assistance to those initially dealing with severely injured patients as well as to those planning improvements in the resources for such care. It is to the patients and the staff looking after them that this document is dedicated.
Medicine and Health Sciences | Surgery
Luke LC, Browne G, Cahill R, O'Flanagan S, Watson G. Initial Management of the Severely Injured Patient Clinical Guidelines. Dublin: Royal College of Surgeons in Ireland. 2003.