The national major trauma system within the United Kingdom: inclusive regionalized networks of care

Abstract The United Kingdom has a population of 67 million people and is divided into 4 nations: England, Wales, Scotland, and the North of Ireland. Healthcare is provided free to all within each nation via the National Health Service (NHS), which is funded by taxes and national insurance payments. Each year, there are approximately 22,000 cases of “major trauma” in the UK across the four nations. Prior to 2010, trauma patients in the UK were managed at any acute hospital with an Emergency Department, irrespective of resource availability or clinical experience and expertise. In the late 2000s, national reports identified significant variation or serious failings in the organization of UK trauma care. These reports, together with political drivers for centralized services, led to the formation of the national major trauma system made up of regional trauma networks. England was the first nation to implement the system in 2012 and this re-organization of major trauma care was associated with a 19% increase in the odds of survival for patients who reached hospital alive. This paper will provide an overview of the positive attributes and challenges within 6 key components of the national trauma system: pre-hospital care, facility-based care, trauma networks, the trauma registries, rehabilitation and governance, financing, and quality assurance.