Where we operate

Our interactive map below shows the hospitals in our Network, the different coloured ‘pin markers’ denote the type of trauma care they provide – click on the ‘pin markers’ to find out more

Components of a major trauma network

Pre-hospital care: Care provided by healthcare professionals / emergency responders who attend the scene of an incident usually by ambulance but sometimes by helicopter (air ambulance), or in a rapid response vehicle (RRV).  These professionals assess the patient’s injuries and transfer the patient from the scene of the incident to the most appropriate care facility.

For the majority of patients in Greater Manchester, this service is provided by the North West Ambulance Service NHS Trust (NWAS). 

A small number of seriously injured patients are conveyed by North West Air Ambulance (NWAA) 

In order to deliver appropriate triage at the pre-hospital stage and to identify the optimal destination, NWAS has developed a triage tool  which is called the  ‘Paramedic Pathfinder – Major Trauma in Adults’.  All eligible front-line staff members have been trained in the use of the major trauma pathfinder tool.  NWAS has also established a 24/7 Complex Incident Hub (formerly referred to as ‘Trauma Cell’).  The hub provides support to staff when making decisions about the appropriate destination for patients falling into the major trauma category.  It ensures correct resources are dispatched and that receiving trauma centres are fully aware of the patient condition in time for the patient arrival.

Hospitals within a trauma network are designated as either a Major Trauma Centre (MTC), a Trauma Unit (TU) or a Local Emergency Hospital (LEH).

Major Trauma Centres: These are hospitals that are designated to provide definitive care for the most severely injured patients. They have the facilities and specialist services needed to manage complex injuries and recovery.  In Greater Manchester, patients with suspected major trauma are usually conveyed to the MTC following a pre-hospital assessment by the North West Ambulance Service (NWAS).  Patients may also self-present, and some patients are transferred in from other hospitals if it has been established that the patient’s injuries are severe enough to require the services of the MTC.

There are two adult MTC sites in Greater Manchester:

• Salford Royal Hospital
• Manchester Royal Infirmary

There is one children’s MTC in Greater Manchester:

• Royal Manchester Children’s Hospital

Trauma Units: The role of a TU is to accept and manage, at any time, arrival of patients from the following two groups:

• Those critically injured who are too far from an MTC to be taken there directly.  The team at the TU are responsible for resuscitating and stabilising these ‘pit stop’ patients before their onward journey to the MTC.
• Those considered to have less severe injuries not requiring the expertise of the MTC  e.g. patients with simple fractures of one limb, lacerations and minor head injuries.

In Greater Manchester the Trauma Units are:

• Stepping Hill Hospital
• The Royal Oldham Hospital
• Royal Albert Edward Infirmary (Wigan)

Local Emergency Hospitals: These are hospitals within the Major Trauma Network that do not routinely receive acute seriously injured trauma patients via the ambulance service. There are processes in place that assist Local Emergency Hospitals (LEH) so that should this occur, patients are appropriately transferred to an MTC.  They may participate in the care of major trauma patients once the patient has completed a period of specialist care. They may also take care of these patients if, following discussion with specialist service, it is deemed more appropriate for the patient to be cared for at their local hospital.

In Greater Manchester the identified Local Emergency Hospitals are:

• Royal Bolton Hospital
• Fairfield General Hospital
• Macclesfield District General Hospital
• North Manchester General Hospital
• Tameside General Hospital
• Wythenshawe Hospital

What we do

The aim of the Greater Manchester Major Trauma Network is to improve care for Major Trauma patients.   This includes the emergency response to an incident followed by subsequent hospital care but it also includes work around rehabilitation, recovery and prevention of major trauma.

We work with multi-disciplinary clinical teams (doctors, nurses, paramedics, allied health professionals etc.) to improve patient pathways and to deliver a high quality service.  Our aims include:

• Development of guidance and protocols for all those involved in the care of major trauma patients in GM
• Standardisation of the patient journey
• Equal, timely access to major trauma services for all GM patients (or patients who present within the network area)

We examine data and conduct audits; we review how we’ve managed cases and if we think it could have been managed better, we change our protocols and make sure learning from those cases is shared with the whole network.  We are always looking at ways to improve care delivery and patient experience.

How we work

As a clinical network, we are part of the GM Critical Care & Major Trauma Operational Delivery Network (ODN).  The ODN is funded by commissioners of specialised services at NHS England and NHS Improvement. The ODN is hosted by Manchester University NHS Foundation Trust.

The ODN has a management team comprising (speciality) Medical Leads, Network Manager, Network Lead Nurse, Quality Improvement Lead and Network Administrator.  Within the Trauma Network we also have consultant leads for rehabilitation, clinical governance,  surgery and frailty.

Network business is managed through the following groups:

Operational Delivery Network Board: This is a quarterly, joint Critical Care and Major Trauma Board. It is responsible for system leadership and strategic direction. It includes provider and commissioner membership and holds the individual healthcare providers to account for their critical care and trauma services.

Clinical Effectiveness Committee (CEC): Meets quarterly and aims to bring together wider Network representation including each individual MTC, TU and LEH.  It also has multidisciplinary representation including nurses, pre-hospital staff, advanced practitioners, allied health professionals (AHPs), and all trauma related specialties (e.g. emergency medicine, neurosurgery, general surgery, orthopaedics, critical care, radiology etc.).

The CEC looks at the following aspects of service provision:

• Development and implementation of guidelines and clinical pathways
• Data review (Trusts are asked to present their data dashboards and clinical reports on a rolling basis, including reporting against key performance indicators)
• Audit and risks
• Death and disability
• Training, education and research

Clinical Governance Group: A bi-annual sub-group of the Network Clinical Effectiveness Committee, the purpose of this group is to discuss and review clinical incidents and clinical pathways.  It aims to identify common themes, areas of good practice and areas of practice where improvements can be made in the pathway of care. Membership of the group includes the Network management team, North West Ambulance Service, the Trauma Leads from the MTCC and representatives from TUs and LEHs.

Members of this group also undertake death and disability reviews; these are peer led meetings held on a rolling basis with individual trusts. These meetings focus on unexpected survivors and deaths.

Network Rehabilitation Development Group: Meets quarterly and is responsible for determining rehabilitation strategy (specialist and generic) for the major trauma network.

Major Trauma Nurse Meeting: this forum provides an opportunity for nurses in trauma to meet and be updated on national major trauma strategy as well as local information pertinent to trauma care in Greater Manchester. This group provides an opportunity for collaborative projects with a focus on education, audits and shared learning opportunities with specialist speakers.