Management of the patient with major trauma

The process of trauma care has both organizational and medical aspects. The requirement for a trauma team in each hospital that receives major trauma is still an unachieved goal in the UK. Further, those hospitals that have such teams do not necessarily provide sufficient experience to permit a universally high level of care. It is likely that centralization of trauma care will occur in the UK, as is happening for a number of other conditions. However, this will bring requirements for a rapid and safe transfer system from the scene to such centres, bypassing centres without requisite experience; this goal remains a distant one in the UK. The management of the head-injured patient is largely directed towards the prevention of high intracranial pressure. The role of surgical craniectomy is under current study, and this could prove to be an additional tool in the management of patients with low cerebral perfusion pressure.