SLO 4 – Care for injured patients across the full range of complexity

This outcome relates to the care of injured patients presenting to the ED across the full range of complexity and severity. It includes being an expert in diagnosing and managing low energy injuries, through to multi-disciplinary major trauma team leadership.

Domain 1: Professional values and behaviours
Domain 2: Professional skills
Domain 3: Professional knowledge
Domain 4: Capabilities in health promotion and illness prevention
Domain 5: Capabilities in leadership and team-working
Domain 6: Capabilities in patient safety and quality improvement
Domain 7: Capabilities in safeguarding vulnerable groups

At completion of ACCS, a trainee will:

  • Be an effective member of the multidisciplinary trauma team
  • Be able to assess, investigate and manage low energy injuries in stable patients and know when to seek help

At completion of training and EM specialist will:

  • Be expert in assessing, investigating and managing patients attending with all injuries, regardless of complexity
  • Provide expert leadership of the Major Trauma Team

An EM specialist is / can:

  • Able to perform primary/secondary trauma survey
  • Have examination skills required to identify/diagnose injury including vascular and neurological consequences
  • Appropriately use investigations including XR/CT/US/MRI to confirm presence/consequences of injury
  • Provide basic management of wounds, soft tissue injuries, fractures and dislocations including local anaesthetic techniques
  • Provide safe use of basic local anaesthetic techniques e.g ring block, fascia iliaca block
  • Use a range of techniques for wound closure (simple dressing, suturing, skin adhesive, steri-strips).
  • Know the fundamentals of management of fractures and dislocations (slings, splints, basic plastering, manipulation as appropriate)
  • Able to remove foreign bodies from the eye and ear.
  • Provide opportunistic advice on accident prevention.
  • Understand the pathophysiology and management of injury (including specific populations e.g. elderly, paediatric and pregnancy
  • Understand the social/economic consequences of injury upon individual and society including specific knowledge of the implications of violent crime (e.g. gun or knife)
  • Estimate a timeline of healing and give general and specific safety net advice on concerning features of potential complications.
  • Understand the importance of considering safeguarding of vulnerable patients
  • Apply CT guidelines for suspected head and cervical spine injuries
  • Provide initial care for patients with fractured neck of femur
  • Evaluate frail patients who have fallen to identify injuries sustained

RCEM Learning resources
ATLS (more suited to core training)
ETC (in higher training)

‘Ring-fenced’ time spent in Minor injuries area in core/intermediate and higher training for experiential learning participation in trauma teams where possible throughout training (whilst in TUs/MTCs)

At least 6 months in designated MTC in HST with direct experience of TTL role with consultant review and feedback

Simulation based learning of trauma team leadership

In core training learners will be expected to seek feedback on the care of injured patients, including patients the frail elderly, and develop the fundamentals in this outcome. They will also be expected to be part of the major trauma team and receive feedback on their role.

Suitable WPBAs include RCEM assessment App; Mini-cex; CBD; ACAT

Trainees would be expected to be given feedback on team leadership of multiply injured patients, under direct TTL guidance. They are also expected to continue to develop skills and decision making for injured patients, for example with cross sectional imaging.

Suitable WPBAs include RCEM assessment App; Mini-cex; CBD; ESLE.

Trainees will be expected to receive feedback on the management of increasingly complex major trauma cases, under direct TTL supervision.

Suitable WPBAs include the RCEM assessment app, CBD and ESLE.

Entrustment decisions

End of ACCS level 2b:

Trainees at the end of ACCS should be entrusted to participate in trauma resuscitations as member of trauma team directed by TTL. They should be also be able to take a reliable history, elicit key examination features, construct a differential diagnosis and carry out a management plan in patients who have sustained non-life threatening injuries within the ED. Observation in the workplace and WPBAs will support a faculty entrustment statement to this effect.

End of intermediate training level 3:

At the end of CT3 clinicians should be able to Act as TTL for trauma resuscitation cases with Consultant supervision within Resus. They should also be able to lead a Minors or Majors area of the ED providing advice to more junior trainees/ACPs/ENPs regarding care of injured patients with Consultant supervision available if required. Observation in the workplace, WPBAs (particularly ESLE), exam progress (OSCE) will support a faculty entrustment statement to this effect.

End of HST Level 4:

At the end of training, independent practitioners will be able to act as an independent Trauma Team Leader across the full range of complexity, supervise others, support the team in debrief and communicate with patients, relatives and love ones and other agencies in all circumstances.

RCEM examinations

MRCEM 
SBA
OSCE
FRCEM
SBA
MSO

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