Appendix: Recommendations that might have particular implications for service delivery

Tables 1 and 2 below contain links to recommendations for pre‑hospital and hospital management of major trauma in the NICE guidelines fractures (complex), major trauma, major trauma: service delivery and spinal injury that might have particular implications for service delivery. They do not list all the services needed to provide care for patients with major trauma.

The recommendations were reviewed by the guideline committee to identify those with an impact on services through:

  • timing – the timing an intervention should be given

  • destination of the patient – triaging decisions, initial destination or secondary transfer

  • availability of a service – the routine availability of an intervention

  • staff skills – expertise not routinely available.

The tables are arranged by clinical area, in alphabetical order.

Table 1 Pre‑hospital management of major trauma: recommendations with implications for service delivery

Clinical area



Airway management

Basic airway manoeuvres and adjuncts

Drug‑assisted rapid sequence induction of anaesthesia and intubation, delivered within 45 minutes of the initial call to the emergency services

Supraglottic devices

Chest trauma

Open thoracostomy

Needle decompression

Ultrasound performed by specialist team

Circulatory access

Peripheral venous access

Intra‑osseous access

Fracture, open

Prophylactic antibiotic treatment, delivered as soon as possible and preferably within 1 hour of injury

Fracture, pelvic

Pelvic binder application, including purpose‑made and improvised pelvic binders

Spinal injury

In‑line spinal immobilisation

Assessment using Canadian C‑spine rule

Table 2 Hospital management of major trauma: recommendations with implications for service delivery

Clinical area



Circulatory access

Peripheral intravenous access

Intra‑osseous access


Standardised documentation used throughout a trauma network

Pre‑alert information received by senior nurse or trauma team leader in the emergency department, who determines the level of trauma team response

Documentation completed by designated member of trauma team and checked by trauma team leader


Immediate haematology consultation for anticoagulation reversal

Laboratory testing of coagulation to guide blood product protocol

Plasma and red blood cells for fluid replacement

Information and support for patients, family members and carers

A healthcare professional to facilitate delivery of information

A dedicated member of staff for unaccompanied children and vulnerable adults to contact next of kin and provide personal support

Radiology, imaging

Immediate CT

Whole‑body CT

Immediate eFAST (extended focused assessment with sonography for trauma)

FAST (focused assessment with sonography for trauma)



Immediate radiology consultation to interpret results of imaging

Radiology, interventional

Interventional radiology for haemorrhage control


Damage control surgery

Definitive surgery

Immediate surgery to explore hard signs of vascular injury

Surgery, neurosurgery and spinal

Specialist neurosurgical or spinal surgeon on call immediately for patients with a spinal cord injury

Local spinal cord injury centre consultant

Surgery, orthopaedic

Surgery for pilon fractures, performed within 24 hours of the injury

Surgery, orthopaedic and plastic

Surgery performed concurrently by consultants in orthopaedic and plastic surgery to achieve debridement, fixation and cover of an open fracture

Surgery, pelvic

Consultation with pelvic surgeon for unstable pelvic fracture

Wound care

Negative pressure wound therapy for open fracture wounds

Photographs of open fracture wounds, taken in accordance with a protocol

ISBN: 978‑1‑4731‑1682‑5

  • National Institute for Health and Care Excellence (NICE)