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Major trauma centre bypass decision — DIPIMC MCQ

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HardRetrieval and TransportMajor trauma centre bypass decisionDIPIMCDipIMC

A 24-year-old is extricated from a high-speed car crash with a suspected unstable pelvic injury and a systolic blood pressure of 95 mmHg. A local emergency department is 10 minutes away and a major trauma centre is 35 minutes away by road. He meets major trauma triage criteria. What is the most appropriate transport decision?

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Correct answer: B — Transport directly to the major trauma centre, as he meets triage criteria for definitive multi-specialty care

A patient meeting major trauma triage criteria — here a high-energy mechanism with a suspected unstable pelvic injury and hypotension — benefits from direct transport to a major trauma centre even if this bypasses a closer non-specialist unit, because definitive haemorrhage control, interventional radiology and multi-specialty care improve outcomes. Diverting to the local emergency department introduces delay through a secondary transfer of an unstable patient. Provided the extra travel time is within the locally agreed limit, the major trauma centre is the correct destination. Pearl: apply a pelvic binder at the level of the greater trochanters before departure in a suspected pelvic fracture with hypotension.

Reference: NICE NG39 (Major trauma); JRCALC Clinical Guidelines