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Urgent and emergency care services in England

Major trauma services

A trauma system is a model of care designed to care for patients with multiple serious injuries that could result in death or serious disability, including head injuries, life-threatening wounds and multiple fractures.

Major trauma centres are set up to provide this specialised care. They are hubs that work closely with a series of local trauma units.

Major trauma centres operate 24 hours a day, seven days a week. They are staffed by consultant-led specialist teams with access to the best diagnostic and treatment facilities, including orthopaedics, neurosurgery and radiology teams.

Pre-hospital care

Ambulance crews will make an assessment at the scene using triage tools to ensure that those with major trauma are taken to a major trauma centre for urgent treatment.

This may involve bypassing their local hospital so they can immediately receive specialist care with access to CT scans and innovative technology. Other patients may have to be taken to their local trauma unit first for stabilisation before they can transfer to the major trauma centre for definitive treatment.

Pre-hospital care is crucial – it means the ambulance service and the helicopter emergency medical service work closely with the major trauma network to ensure the most urgent patients are sent to the most appropriate place.

What happens at the trauma centre?

Once patients arrive at the trauma centre, they will undergo a focused assessment by a specialist trauma team trained to deal with these types of injuries.

Major trauma centres also treat children. The management of specific injuries and drug administration will differ for children, but the focused response from a specially trained trauma team will essentially be the same.

In life-threatening situations, the doctors and nurses from the trauma team will do what is required to save a person's life. If the patient is unable to give consent because they are incapacitated, treatment will still be carried out.

In these cases, the reasons why treatment was necessary will be fully explained once the patient has recovered. For more information, see the section on When consent isn't needed.

All relatives will be allowed to visit patients both at their bedside and in the ward. See the section on Visiting someone in hospital.


Patients who have suffered a severe injury often need complex reconstructive surgery and care from many professionals, such as physiotherapists, occupational therapists and speech and language therapists.

This care is very important and many patients need a personalised rehabilitation programme to help them return to an active life, which can take many months. This care may take place at the major trauma centre or other units in the area.

What does good trauma care look like?

Good trauma care involves getting the patient to the right place at the right time for the right care. This means:

Trauma care flow chart

  • Having the seriousness of the injury identified as early as possible, ideally at the scene of the incident.
  • If this is not possible, investigations such as CT scanning should take place immediately on arrival at the first hospital.
  • If the injury requires specialist care, the patient should be moved to a major trauma centre as quickly as possible.
  • Patients should have access to an appropriate programme of rehabilitation to assist their recovery.  

How the NHS is improving major trauma care in England

It has been estimated that by improving the organisation of trauma care, an additional 450 to 600 lives could be saved in NHS hospitals. With detailed planning, regional trauma networks went live across England in April 2012. These are based on agreed principles of care using local models and implementation in each geographical area.

You can download a map showing the location of the major trauma centres (PDF, 1Mb), some of which treat both adults and children, while others specialise in the treatment of either adults or children.

Page last reviewed: 19/08/2014

Next review due: 19/08/2016


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