Major trauma centre

Major Trauma

Please note:

This is a general information booklet for all patients who have been admitted to hospital after major trauma. There are many types of injury and people deal with their injuries in different ways, the impact of which depends on your individual circumstances. For more specific information you may wish to talk to a member of the trauma team.

This leaflet is based on the experience of other people who had similar injuries and the kind of information that they found useful during their hospital stay and recovery.

What is a Major Trauma Centre?

A major trauma centre (MTC) is a specialist hospital responsible for the care of the most severely injured patients involved in major trauma. It provides 24 hours a day, 7 days a week emergency access to consultant-delivered care for a wide range of specialist clinical services and expertise.

People who suffer serious injury require the highest quality specialist care to give them the best chance of survival and recovery. The James Cook University Hospital is the Major Trauma Centre (MTC) for the South Durham, East Cleveland, Tees Valley and North Yorkshire areas.

What is Major Trauma?

Major Trauma describes isolated or multiple injuries that may result in death or disability. Approximately half a million people are admitted every year following serious injury. Common causes of injury are road traffic accidents, work injuries, acts of violence, falls and sporting injuries.

Major Trauma can be life changing for you and your family over a long period of time. You may be affected emotionally as well as physically, it can take time to adjust and adapt to what has happened.

Evidence shows that many of those admitted with major trauma have not fully recovered one year later. It is therefore important to allow yourself the time your body needs to heal and recover. This will depend on a range of factors dependant on your pre injury age, health and injury occurred.

One of the most important things to remember is that you are not alone and there are many people in similar circumstances and there are services available to support you and your family.

How long will I stay in the Major Trauma Centre?

This will depend on your treatment plans. Patients remain here until stable and the team are happy for you to be discharged home or transferred to another hospital or care setting. If you are from outside of our NHS trust area, we will attempt to transfer you to a hospital closer to home if you have ongoing care needs. If you have ongoing rehabilitation needs we may transfer you to a specialist rehab unit.

Your treatment and recovery will depend on a number of factors including type of injury as well as your age and health prior to the injury.

Some serious injuries involve internal organs as well as soft tissue and nerves. It can take much longer to recover from an injury than you might think. Many people are still not fully recovered one year later. It is important to allow yourself the time to recover and heal.

Serious injuries occur when we least expect them and can be life changing for you and your family. It can affect you emotionally as well as physically, taking time to make adjustments to your life. Recovery can be out of your control but there are some steps you can take that will help you on your road to recovery.

Admission

The Major Trauma Ward at The James Cook University Hospital is Ward 36 which is located on the second floor of the hospital, above the South entrance. Ward 36 is usually the ward you will be admitted to following your injury. Occasionally if your injuries are severe or you require closer observation you may be admitted to one of our Critical Care Units.

Depending on the nature of your injury you may require care on a specialised ward, examples of this would be a severe brain injury requiring surgery, cardiothoracics or spinal cord injury.

Facilities

Car parking

A regular visitors car parking permit is available at a reduced cost. Forms are available at North ad South reception or ask a member of the ward staff.

Bus

Connectteesvalley.com

Train

There are train links direct to James Cook Hospital.

Visiting tImes

Visiting times are 2pm to 4:30pm and 6pm to 8pm. Please check with wards before visiting.

Accommodation for relatives

There are a number of hotels within close proximity to the hospital should you require it.

• Premier Inn (Opposite hospital): Telephone 0333 321 1327
• Premier Inn, Middlesbrough centre: Telephone 0333 234 6599
• Travelodge, Middlesbrough: Telephone 0371 984 6375
• Jurys Inn, Middlesbrough: Telephone 01642 232000
• Cross Keys, Guisborough: Telephone 01287 610035
• Sporting Lodge, Middlesbrough: Telephone 01642 578100

Funding

Through our partnership with Day One Trauma Support, in special circumstances we can help with funding for accommodation, travel, parking and other costs related to major injury. Please speak to a member of the team looking after you regarding this.

Food and drink

Food and drink is available in the following areas. Opening times are available from ward areas:

• Main restaurant
• Deli bar (within main restaurant)
• Lavazza (Back of main restaurant)
• Hospital volunteers coffee shop
• Costa coffee (South Mall)
• Vending machines are situated throughout the hospital

Shops

• W. H. Smith – Newsagents (South Mall)
• Marks & Spencer Simply Food (South Mall)
• WRVS (North entrance)

Chapel and prayer room

The Chapel of the Good Samaritan, near the north entrance, is open and lit during the day and the night for you, your family and your friends to visit. It’s a special place of peace and quiet, of prayer, stillness and reassurance. It is hoped that people of many faiths and none, will find it a tranquil and safe haven.

There is a Muslim prayer room and wash facility adjacent to the chapel at James Cook.
Services in the chapel:

• Monday 1pm – Roman Catholic mass
• Wednesday 1pm – Church of England and Free Church Holy

Communion

The chaplains can be contacted either on [email protected] or on the following number, where non-urgent messages can be left on the voicemail: 01642 854802

Bedside TV, radio and telephones

Telephones and TV’s with headsets are installed by each bedside. You can receive free incoming telephone calls. Free TV until midday.

Care in hospital

Coma and reduced alertness

After a traumatic injury you may be unconscious for some time. This can be due to different reasons. If you have been very unwell then you may have been admitted to Critical Care. You may have been placed in a medically induced coma until you got better.

Unconscious patients on Critical Care will have a patient diary written by nursing staff and your relatives. The diary will inform you of what happened while you were unconscious and is yours to keep after discharge from ICU.

When you are transferred from Critical Care to the ward you will continue to be seen by the Critical Care Outreach Team until they are satisfied that you no longer need their specialist input. The Outreach team will be able to answer any questions about your stay on Critical Care.

Nutrition

People who sustain traumatic injuries, especially those who have multiple injuries or have been on Critical Care are at increased risk of losing weight and muscle mass. This can because you have been in bed a long time and therefore not using your muscles.

You may be having surgery which uses up extra energy. To replace that energy you will be encouraged to eat a high protein diet and may be offered protein shakes.

If you have been to Critical Care you may have a feeding tube until it is safe to take regular diet and fluids. A dietician will be involved in you care if you have been to Critical Care. You may be referred from the ward if you are struggling with your nutritional intake.

Constipation

Whilst in hospital you may experience constipation due to reduced levels of activity and the side effects of pain relief. It is important to inform staff if you are constipated and we will then give you medication to help with this (laxatives).

You should eat foods that are high in fibre such as fruit, vegetables, and cereal. Drink plenty of non-carbonated fluids. Aim for at least 3 jugs of water per day.

Smoking

James Cook University is a No smoking site.

Smoking can affect bone and wound healing and increases your risk of a chest infection whilst in hospital. If you smoke and need help whilst you are in hospital or if you would like to stop, please discuss this with your nurse. We can prescribe Nicotine Replacement Therapy for you.

Pain management

Pain is very individual and dependent upon the extent of your injuries and an individual’s perception of pain and response to pain relief. It is very important that pain is managed in order to enable mobilisation and deep breathing exercises which in turn reduce the complications associated with immobility.

Whilst in hospital we will assess you to see which is the most appropriate analgesia for your type of pain. Pain relief is prescribed and adapted for each individual and may be given by a variety of routes and methods.

As well as taking medication in tablet form, we may also give it via other routes. Patient controlled analgesia (PCA) is sometimes given for a few days which will allow you to control your own analgesia as well as being given oral analgesia to supplement it. In some cases, if you have rib fractures, you may have an Epidural or Erector Spinae Plain Blocks (ESPB). This is a continuous infusion of local anaesthetic.

Emotional support

After experiencing or witnessing a traumatic event, it is typical to experience a range of strong physical feelings and emotions. These are normal reactions to an abnormal event.
For many these symptoms disappear in several weeks but for some people may not develop symptoms until several months later. Your mood can be further impacted due to the hospital environment and routines.

Day One can provide counselling for family members or others who may be affected by your accident. Please discuss with our Day One case manager. We can also refer you to our Major Trauma Psychology team, who can talk you through common reactions to trauma and discuss coping strategies with you.

Day One Trauma Support

Day One can provide practical and emotional support to help you manage your circumstances and make the best possible recovery following a major physical trauma.

Support is available relating to legal and welfare benefits advice, emergency funding and family counselling. Our Day One support worker will introduce themselves to you on the ward and discuss any support you may need.

Sick notes

If you were working at the time of your accident we would advise that you contact your employer for advice on sick pay. You can self certify for the first seven days. If you require a fit note please ask a member of staff who will organise this for you.

For guidance on the fit note see: www.gov.uk/government/collections/fit-note

If you are struggling financially after an accident please contact Citizens Advice who can offer advice on money issues and on benefits available. The Department for Work and pensions also lists benefits and allowances available.

Some people find that the first few days at home are more difficult than they expect. Simple things that you used to do without thinking can become a challenge, like washing dressing and cooking. Getting around the house can also be difficult.

Some people report feeling alone when their care in hospital has stopped. The transition home can be helped by considering some of the points below.

• Take some pain relief before leaving the ward.
• Wear loose comfortable clothes.
• Ask the person who collects you to bring a pillow or cushion so you can be comfortable on the journey home.
• If you are leaving hospital after a road traffic accident you may be anxious about the journey home. Talk to your family about this before the drive home.
• Drive more slowly.
• Travel with people you trust.
• Take deep breaths.
• Distract yourself by talking or listening to music that calms you.
• If you are going on a long journey stop off at a service station midway. Most service stations have wheelchairs that you can use.

When you get home you may be physically and emotionally drained. This is normal, your recovery may be slow to start. It may be helpful to think about your progress week by week rather than on a daily basis.

It takes time to re-establish a normal routine with your sleeping pattern, appetite, pain control and usual toilet routines. Mobility and confidence can all be affected and take time to get back to usual. Try to continue the activities and exercises you were given in hospital. Your relatives may also be feeling a range of different emotions too. Take time to talk to them.

If you need additional equipment to help you manage at home The British Red Cross may be able to loan it to you.

Looking after yourself

Recovering from a serious injury can take time, there are things you can do to aid your recovery.

Nutrition

It is common to have a reduced appetite following a trauma or post surgery. Changes in bowel habits, medications and mood can further affect your appetite and how you feel about food.

Following a severe injury and/or surgery you need to eat more protein, calcium and vitamins (especially Vitamins C & D) to heal bones and soft tissue. If you have lost weight during your admission or are losing weight you also need to eat an energy dense diet (high in calories).

Constipation is very common due to reduced mobility, poor appetite and pain relief medication. Eating more fibre and drinking plenty of fluids (water) will help. Only gradually increase the fibre in your diet. As your appetite improves try to introduce foods that are rich in protein, calcium, vitamins and fibre into your diet.

Overeating

It can be easy to gain weight due to reduced mobility and overeating due to low mood, stress and boredom. It is important to monitor your food as excessive weight gain will not improve your physical or emotional wellbeing.

Emotional wellbeing

People can often have strong emotional reactions after serious injury. This is normal. You have experienced a traumatic event which may have impacted upon a number of areas of your life. That could be your ability to work, enjoy your previous hobbies, your independence, mobility, relationships.

Emotional difficulties that can occur include:

• Feeling low and tearful.
• Feeling anxious, panicky, worried or as though something bad is going to happen.
• Difficulty adjusting to things being different or feeling stuck.
• Flashbacks, nightmares or unwanted memories of the event that led to your injuries.
• Getting upset when thinking or talking about what has happened.
• Avoiding situations, people or places that remind you of what happened.
• Distress or self-consciousness about scarring or any other changes to how your body looks.
• Fear about driving or travelling in vehicles.
• Difficulty doing what healthcare professionals are recommending.
• Physical symptoms such as pain, sleeplessness and reduced mobility.

It can also affect those around you and put a strain on relationships. It is important to think about how your injuries are affecting you emotionally. Ignoring the emotional impact of serious injuries is often unhelpful. It is worth remembering that once you begin to heal or have healed physically, emotional difficulties do not necessarily go away.

When and how to get help

Some degree of emotional upset is normal, and many difficulties naturally fade within the first few weeks. If these feelings are distressing or interfering with your life then it is advisable to talk to your GP.

Personal hygiene

You can have a bath or shower unless told otherwise. If you have a plaster on or a dressing you must protect it to prevent it from becoming wet.

Wound care

Keep wounds clean and dry while the dressing is still on. Dressings do not need to be changed daily as this increases the risk of infection. Once the dressing is removed and the wound exposed you can wash with soap and water and gently pat the wound dry.

You may be told to see a practice nurse or district nurse for a wound check and dressing change, or you may need to come back to clinic. You will be told which you need before discharge.

Pain and pain relief

People deal with pain in different ways. We all differ in how we experience pain and how much pain is tolerable to us. It is often influenced by previous experiences of pain. When people experience pain they may become anxious or tense their muscles both of which increase pain perception.

Expect to feel pain and discomfort. Taking regular pain relief as prescribed can help relieve this and help you manage day to day. Don’t wait until the pain is unbearable before taking your pain relief. This makes managing pain more difficult and you may find it difficult to cope with.

Remember that pain is a normal part of the healing process. You do not need to finish all of the pain relief prescribed if you feel you don’t need them. Some medication can cause unpleasant side effects with prolonged use or if stopped suddenly. Please read the literature supplied with your medication and discuss any concerns with your GP.

See your GP if you need a repeat prescription. You may find it worthwhile getting a pre-payment prescription. You can save money if you pay for your prescriptions and need more than 3 items in 3 months.

Alcohol

If you enjoyed a drink before your injury you may continue to do so afterwards unless it is not advised with your medication.

Try to spread your intake over the week and keep your drinking within the recommended guidelines (Maximum 14 units per week for men and women). Some people may be tempted to drink more after an injury however excessive alcohol can cause:

• Changes in emotional state
• Poor sleep
• Reduced appetite
• Delayed healing
• Obesity
• High blood pressure
• Increased risk of falls
• Impaired thinking

If you have sustained a Head Injury you may be advised to stop drinking alcohol.

When and how to seek help

Medical support at home

Your GP is responsible for your care in the community. They can refer you to a range of services and deal with most issues once you are home. Your practice nurse is responsible for your wound care, district nurses will come to your home but only if you are unable to get to the practice.

Specific problems requiring medical attention

Plaster problems

If your plaster feels tight and there is excessive swelling in your fingers or toes your plaster needs to be checked. If your plaster becomes loose or wet please contact us.
The plaster room can be contacted directly, Monday to Friday, on the contact details at the end of this leaflet.

Wound problems

An increase in the following symptoms may suggest a wound infection.

• Heat
• Redness
• Swelling
• Discharge
• Pain
• Feeling generally unwell

If you have problems with a VAC dressing please contact the ward you were discharged from for advice

Leg pain

A combination of the following symptoms may suggest a blood clot in your leg:

• Pain, swelling and tenderness in one of your legs.
• A heavy ache in the affected area.
• Warm and red skin in the affected area, usually at the back of your leg below the knee.

Constipation

If you are taking laxatives on discharge, you will need to continue to take them whilst you are on pain relief medication. If you experience loose stools hold off for a few doses, but do not stop them completely until you have normal bowel habits. Drink plenty of fluids and take a high fibre diet.

See advice on nutrition.

Breathing

If you are feeling unwell and feverish and have a productive cough you should contact your GP

• Chest pain, a sharp stabbing pain that may be worse when you breathe in.
• Shortness of breath.
• Coughing, which is usually dry but you start coughing up blood or mucous containing blood.

Moving on

Driving

Driving with a leg or arm in plaster can be seen as a driving impairment and therefore considered to be dangerous driving. Driving with a neck or back brace is also viewed as a driving impairment. Most insurance companies will not cover driving in a cast or brace. It is not an injury that requires you to report to the DVLA, but you should check with your insurance company how far post injury they will insure you.

Head Injuries

DO NOT DRIVE OR OPERATE HEAVY MACHINERY if you have been told by the medical team not to do so.

You will be told if you need to contact the DVLA. It is your responsibility to do this. You will need to complete and submit a ‘Report your medical condition’ Car or motorcycle licence – Form B1, Bus, coach or lorry licence – Form B1V.

You could be fined up to £1,000 if you do not tell the DVLA about a condition that might affect your ability to drive safely. You could also be prosecuted if you have an accident.

Going back to work

The timing of returning to work depends upon the nature of your work and your injuries. You may want to discuss this with your doctor or your works occupational health department.

You may need to make some adaptations at work and start with a graduated return to work.

Outpatient appointments

Most injuries will require follow up. Most follow up appointments will be sent in the post. If you have not received any follow up appointments, please contact the ward you were discharged from.

Transport for outpatient appointments

Transport is not routinely arranged for your outpatients follow up. Please try to get someone to bring you to your appointment but if this is not possible please arrange yourself through your GP.

Blue badge

You may be able to get a blue badge to make getting out and about easier following your injury. To apply contact your local council.

Sex after serious injury

The physical effects of injury, stress, mood and thought processes may affect sexual drive. Some injuries may make it difficult to engage in sexual activity. This may improve as you recover from your injuries.

Trauma to the head, spine or pelvic area may also affect nerves and blood vessels supplying the abdomen and pelvic region. This can affect the ability to achieve or maintain erections and experience sensations.

Understandably you may feel embarrassed to talk about sexual problems but by talking to your consultant or GP you may be able to get appropriate support and treatment.

Holidays

You may not be able to fly for up to three months following your injury. If you are unsure ask at your outpatient appointment. Ensure that your travel insurance company is aware of your injuries. You may need to contact the relevant companies’ airline, rail and accommodation in advance if you have any special requirements.

Return to activities and sport

This will depend upon your injury and should be discussed with your consultant or physiotherapist.

Useful agencies

• The British Red Cross
  Loan equipment for short term use.
  Tel: 0344 871 1111
  www.redcross.org.uk
• ICU Steps
  Intensive Care Patient Support
  www.icusteps.org
• Headway
  The Brain Injury Association
  Tel: 01642 983963
  www.headwayteesside.org.uk
• AfterTrauma
  A website that connects and supports survivors of traumatic injury and their families.
  www.aftertrauma.org
• Day One
  Provide practical and emotional support for patients and their families
  www.dayonetrauma.org
• Brake
  A charity for road safety which provides information and resources for victims of road traffic collisions.
  www.brake.org.uk
• The Limbless Association
  Supporting and empowering amputees of all ages to lead independent and fulfilled lives.
  www.limbless-association.org
• Citizens Advice
  Provide free, independent, confidential and impartial advice.
  www.citizensadvice.org
• The Department for Works and Pensions
  Wide range of disability related financial support including benefits, tax credits, payments grants and concessions
  www.gov.uk
• Improving access to psychological therapies (IAPT)
  www.nhs.uk (search talking therapies)
• DVLA website
  www.gov.uk/government/organisations/driver-and-vehicle-licensing-agency
• NHS prepayment prescriptions
  www.nhsbsa.nhs.uk

Useful hospital contact numbers

• Ward 21 (Children’s Ward) – Tel: 01642 854521
• Ward 22 (Childrens Ward) – Tel: 01642 854522
• Ward 24 (Including Neuro HDU) – Tel: 01642 854524
• Ward 26 – Tel: 01642 854526
• Ward 36 (Trauma Ward) – Tel: 01642 854536
• Intensive Care Unit
  ICU 2 – Tel: 01642 282680
  ICU 3 – Tel: 01642 854539
  JGCC – Tel: 01642 854523
• Spinal Cord Injuries Unit Ward – Tel: 01642 282644
• HDU – Tel: 01642 282641
• Major Trauma Team
  Email: [email protected]
  Tel: 01642 835918
  Tel: 07442 790011
• Plaster Room
  JCUH: Tel: 01642 850850, Ext 57412
  FHN: Tel: 01609 764501
• Orthotics – Tel: 01642 944747

Patient experience

South Tees Hospitals NHS Foundation Trust would like your feedback. If you wish to share your experience about your care and treatment or on behalf of a patient, please contact The Patient Experience Department who will advise you on how best to do this.

This service is based at The James Cook University Hospital but also covers the Friarage Hospital in Northallerton, our community hospitals and community health services.

To ensure we meet your communication needs please inform the Patient Experience Department of any special requirements, for example; braille or large print.

T: 01642 835964
E: [email protected]

The James Cook University Hospital, Marton Road, Middlesbrough, TS4 3BW.
Telephone: 01642 850850

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