proofreading of me assignment that will be described underneath

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I need a proofreading of my assignment that about Reducing the mortality rate related to RTA in respect to the West Midland approaches in establishing of MTC around a city. it is just 8 pages and about 3000 words

The research title: Reducing the mortality rate related to RTA in respect to the West Midland approaches in establishing of MTC around a city. The abstract: Road traffic accidents (RTAs) consider the leading cause of death in the worldwide for people who are under 45 years old. This high mortality rate lead some of the devoloped countries to establish new trauma system to reduce the mortality rate of trauma especially from RTAs. These systems brought an idea of Major Trauma Centres (MTCs) which is a specialist hospital contain all the trauma patients needs without a necessity for a further transfer for more advanced hospital. These MTCs have shown a significant reduction in the mortality rate of trauma. Furthermore, almost there is no previous study which examine the effect of those MTCs isolated from other trauma injuries. This study will focus on the MTCs in the West Midland which include three MTCs by a comparison between the data before the establishment of those MTCs, the data after establishment in one year and the last year data. However, there will not be a direct contact with the patients and their data will be coded. However, this research aims to study the effect of MTCs on the reducing mortality rate of RTAs. The research topic: The developing countries suffer from deaths resulting from trauma especially road traffic accidents (RTA) which is consider the leading death in worldwide for the population under 45 years old (Oestern, Garg and Kotwal, 2013). These deaths can be avoided when the government improve the road safety standards and health service systems. On the other hand, some of the developed countries have established new trauma networks to deal with trauma injuries which shows a significant reduction in the mortality rate. Furthermore, in the UK, the new trauma network produce specialist hospitals called major trauma centres (MTCs) contains all the services that trauma patients could need without a necessity to a second transfer to a more advanced hospital. These MTCs have shown a remarkable reduction in the mortality rate of trauma injuries (Davenport et al., 2010). In addition, based on the previous studies in this research in chapter 3, almost there is no research studied the effect of those major trauma centres on RTAs isolated from other trauma injuries. In this research, the effect of MTCs on RTAs patients will be studied using the endpoint of mortality rate. This will illustrate the impact of MTCs for those countries who suffer from a high mortality rate resulting from RTAs. Literature review: Major trauma considers as the leading cause of death in the UK for people aged under 45 years old (Morrissey et al., 2015)(Morrissey et al., 2015) In addition, major trauma is a remarkable cause of disability, causing about 250 million disabilities worldwide each year which resulting in a sever changing in life’s patients(Kieffer et al., 2016) (McCullough et al., 2014) . These changes include especially head and spinal cord injuries which cause the most dangerous disabilities on a community. Both deaths and disabilities resulting from trauma affecting countries by reducing a manpower that the community could use it to improve and develop within that community. For instance, Today, One quarter of the death result from road traffic accidents(Lendrum and Lockey, 2013). These deaths could be preventable if governments ameliorate their health services. From a wider prospective, World Health organization (WHO) estimates that the death because major trauma in 2020 would be the leading cause of death worldwide (Manson et al., 2013). However, major trauma is defined widely as each trauma with Injury Severity Score (ISS) > 15 (Kehoe et al., 2015). ISS is a one of scoring system that describe the severity of the trauma numerically which is used nowadays internationally. This scoring system divide the body into six regions which are: head and neck, face, chest, abdomen, extremities and external, and calculated by the sum of squares of abbreviate injury scale (AIS) for the most severely injured regions of the body (Kehoe et al., 2015) . ISS system helps fieldworkers like paramedics and emergency medical technicians (EMT) to inspect the severity of the injury quickly to decide whether they have to transport a trauma patient to a local hospital or to a major trauma centre. The first major trauma centre was established in the UK in April 2010 located in London as a result of a new trauma network system (McCullough et al., 2014), while major trauma centres were gone live before that in the USA (Davenport et al., 2010),(Morrissey et al., 2015). The idea behind establishing a major trauma centre was to locate a speciality hospital to receive any case of trauma which match the standers that used and centralise the care that a trauma patient could need without needing for a secondary transfer. Nowadays, there are 26 major trauma networks in England and each one has a major trauma centre (McCullough et al., 2014) and department of health has standardized the criteria that each major trauma network has to follow to implement a major trauma centre (Jansen et al., 2015). The effect of those major trauma centres was studied widely on reducing the mortality rate and number of disabilities. Davenport et al (Davenport et al., 2010) state that major trauma centres have reduced the mortality rate within a few years after establishment. In particular, (Shuman and Meyers, 2015) clarified that better outcomes could take from five to eight years to become apparent. In addition, (Stammers et al., 2013) suggest that major trauma centres offer better outcomes for trauma patients than other emergency services while (MacKenzie et al., 2006) state that death after injuries was reduced for patients who were treated in trauma centre more than others who are treated in non-trauma centre. Another study from USA shows that centralization the care provided to major trauma can reduce in-hospital mortality (Lendrum and Lockey, 2013). In particular, road traffic accidents consider the leading cause of death for those who are under 45 years in the world (Oestern, Garg and Kotwal, 2013). In addition, WHO estimate that the road traffic accidents will be the leading cause of death in 2020. In the UK, the road traffic accidents cause about 5400 death each year based on the national audit office. However, despite that (MacKenzie et al., 2006) state that treatment in major centres is more effective when the patients are 55 years, the impact of major trauma centres on trauma was studied widely but almost none study from the previous studies examine the effect of the major trauma centres on the Road traffic accidents particularly. There were some studies which provide some bases of the effect of major trauma centre on road traffic accidents. For instance, (Kehoe et al., 2015) found that the mortality rate was reduced by a half between 1990 to 2013, as a result of establishment major trauma centres with other effective regulations. In 1990, the most common cause of death in the UK was road traffic accident which was represent 60% of mechanisms while in 2013, which is after implementation the major trauma centres in the UK, there was a reduction to reach 30%. In general, the major trauma centres in the UK have another impact not only on the mortality rate. In additions, (Stammers et al., 2013) shows that the major trauma centres provide more than a reduction in the mortality rate. For example, the major trauma centres reduce the time that trauma patients could take to arrive to a specialist care from 205.7 hours to be 37.4 hours. It is believed that transporting the patient to a definitive care is a core role for the emergency medical services to save patient’s lives. Another impact of the major trauma centre is a reduction on the in-hospital stay. Stammers found that, there was an obvious reduction on the length of stay in hospital after the implementation of major trauma centres. In contrast, (Hannon et al., 2013) state that the number of calls and patient admitted to a hospital after establishment of major trauma centre was significantly increased. The number of calls was increased by 200% from 30 calls before major trauma centres to be 90 calls in after while the number of patients admitted to a hospital was increased from 22 to 64 after the major trauma centres. From all the previous studies, this research found that there is a significant gap to study the impact of major trauma centres on the road traffic accidents’ patients. In particular, this research assumes that there are insufficient researches that illustrate the demographical characteristics of those patients. In addition, the effect of these major trauma centres was not studied enough to help those countries that suffer from a high mortality rate as result from road traffic accidents to decide whether the establishing a major trauma centre can help them to reduce the mortality rate or not. The research question: Does the establishing of Major Trauma Centres (MTCs) in the West Midland reduce the mortality rate related to Road traffic accidents (RTA)? The design: This research is a retrospective or a secondary research which means that the data are already exist in the data base and ready to be analysed for further research that required access to those data. This research will be divided to two phases in term of dealing with data. The first phase is the collecting data phase. in this phase, the focus will be on sources of the data, types of the data that will be focusing on and the way of choosing and selecting the data, and. The second phase is the analysing phase where the focusing here will be on the benefit of data analysing methods and the software that could be used to analyse data. The collecting data phase divides to three steps. The first step is the defining of the data sources. The sources that will be used in this research will be Research Audit Trauma Network (TRAN) for the statistics of those patients who admitted alive to major trauma centres. In addition, the data of patients who did not reach to major trauma centres alive will be collected from the calls log that ambulance services or National Health Services (NHS) provide. Furthermore, the data of patients who discharged alive from major trauma centres or died in the hospital will be collected from TRAN and hospital log. The second step is the type of the data that will be collected. These data will be related to the patients, accidents and major trauma centres. For instance, the data-related patients include age, gender and severity of the injury. Furthermore, the data that related to accidents comprise location and time of accidents, transferring time to major trauma centres, type of ambulance services that response to the call, type of the interventions that were provided, the status of the patients when they arrive to the major trauma centres. Afterward, the data-related major trauma centres involve the time of admission and discharge, the type of interventions that were provided in the major trauma centres, 30-day mortality rate endpoint and the status of the patients in hospital. The next step is the way of choosing the data. the data that will be chosen will divide to three periods which are before the establishment of major trauma centres (pre-MTCs), one year after establishing the major trauma centres and data of last year from recent. Each period will include a year and each year will be divided to three durations. From each duration one month will be picked randomly to compare it with the same months on the other years in the study. However, the data of pre-MTCs will be collected from data of the county, the department of health or the data of those hospitals themselves before being a MTCs. The second phase of this study is the analysing data. Firstly, the data will be analysed based on the periods of the study. In particular, the data before establishing major trauma centres will compare with the data after in one year to get the fast impact of establishing major trauma centre while comparing the data before the establishment of major trauma centres with the data last year will explore the long effect of major trauma centres on the public health. In addition, to illustrate the on-going progress of major trauma centres over a period after the establishment until last year, the date after the implementation will be compared with those in the last year. However, there are recommended software that could use to analyses the data. For instance, MATLAP or SPSS which are provided as free for university of Birmingham students. Both software are dealing with quantitative data while NVivo software could help with the qualitative data if there. The population and sample: This research will be focused on the West Midland as a population. The West Midland was chosen as the second highest county population in the UK after London. This ignorance of London refers to the special features of the city that could be difficult to apply it on another city. In addition, London city was ignored because the West Midland have the highest population who over 16 years old (West Midlands Databook 2017, 2017). However, the West Midland have three major trauma centres which includes the Queen Elizabeth Hospital Birmingham, University Hospital Coventry and Warwickshire and Royal Stoke University Hospital. All of those centres will be included in the sample size. Furthermore, this research will concentrate on the patients who had road traffic accidents whether they arrive to major trauma centres or not. In particular, the data of those patients who did not reach to major trauma centres will be collected from calls log while those who do arrive their data will be found in Trauma Audit and Research Network (TARN). For this purpose, a cluster sampling will be used after dividing the sample size into three periods (before MTCs – one year after MTCs – last year of MTCs). Each period will include a whole year while the sample will be the same month in each period. This month will be chosen randomly. The procedure and instrument: First of all, this retrospective research requires a contact with NHS in the West Midland to decide whether the research will need an ethical approval on not. In case yes, the ethical approval will be sought from the online integrated Research Application system (IRAS). Furthermore, NHS will be contacted to have access to the calls log in the specific times of this study. In addition, this research requires an access to the data base of Trauma Audit and Research Network (TARN). After completing all the paper work that will be necessary to implement this research, data collection process will be started. In particular, the data will be collected in specific forms which illustrate patients characterises, major trauma centres statistics and calls log. These forms will be divided into three main parts that each one represents one major trauma centre. In addition, each form will include three sub-group which represent the periods of the study (pre-MTCs, one year post-MTCs and last year MTCs). After that, the data will be exported to a software program preparing it to the analysis process. The instrument that will be used to answer the question research is the comparison between the three periods in the all major trauma centres. Furthermore, the comparison between the pre-MTCs and one year post-MTCs will shows the fast impact of establishing a major trauma centre on the mortality rate of road traffic accidents patients. In addition, the comparison between Pre-MTCs and last year of MTCs will illustrate the long progress of major trauma centres and the impact of this progress on the mortality rate of RTA patients. After that, the comparison between the one year post-MTCs and last year of MTCs will explore the improvement on these MTCs and the effect of these improvement on the patients’ lives. However, the result will be shown in graphs and tables after finishing the data analysis. The ethics: This research will collect the data from the data base like Trauma Audit and Research Network (TRAN) and calls log and analyse them without any contacting with patients. This kind of data include the demographical characteristics of the road traffic accidents patients whom admitted to major trauma centres in the West Midland, UK. These data supposed to be pure and mostly coded. This coding system will protect the privacy of the patients that their data will be collected. However, in case the data were not coded, the approval from the NHS or department of health will be needed. Furthermore, this research required to an access of the data of those patients who dead recently as result of road traffic accidents for the research purpose. These data are necessary for the research to illustrate the mortality rate of the patients of road traffic accidents who arrive to the major trauma centres alive. In this case, it is recommended to contact with Research Ethical Committees (REC) for get an advice wither this research would need to have approval from National Health Services (NHS REC) or not. Based on the ethical principles, and despite the issues that mentioned earlier, this research will not be harmful on the patients where the contact will be with data. In addition, the informed consent will not be required from the patients as there in no directly contact with them. Furthermore, as a result of this study is a retrospective research, there is no deception while the research dealing with the data base. In addition, there is no benefit for the participations as a result of there is no interviews or surveys to participate in. The impact: This research aims to study the effect of major trauma centres (MTCs) on the mortality rate of road traffic accidents (RTAs). This will help countries that suffer from the high mortality rate of RTAs to decide whether these MTCs will be effective in their countries or not. Furthermore, this research will study the progress of these MTCs in terms of dealing with RTAs over the years since it was established. This will show their effect and the ameliorations that will be needed to improve their effectiveness. • References: Davenport, R.A., Tai, N., West, A., Bouamra, O., Aylwin, C., Woodford, M., McGinley, A., Lecky, F., Walsh, M.S. and Brohi, K. (2010) 'A major trauma centre is a specialty hospital not a hospital of specialties', The British journal of surgery, 97(1), pp. 109-117. doi: 10.1002/bjs.6806. Hannon, E., Potter, S., Jaiganesh, T., Muhktar, Z. and Okoye, B. (2013) 'The impact of adult major trauma centre status on paediatric trauma activity', Emergency medicine journal : EMJ, 30(10), pp. 828-830. doi: 10.1136/emermed-2012-201125. Jansen, J.O., Morrison, J.J., Tai, N. and Midwinter, M.J. (2015) 'A survey of major trauma centre staffing in England', Journal of the Royal Army Medical Corps, , pp. 000350. Kehoe, A., Smith, J.E., Edwards, A., Yates, D. and Lecky, F. (2015) 'The changing face of major trauma in the UK', Emerg Med J, 32(12), pp. 911-915. Kieffer, W.K.M., Michalik, D.V., Gallagher, K., McFadyen, I., Bernard, J. and Rogers, B.A. (2016) 'Temporal variation in major trauma admissions', Annals of the Royal College of Surgeons of England, 98(2), pp. 128-137. doi: 10.1308/rcsann.2016.0040. Lendrum, R.A. and Lockey, D.J. (2013) 'Trauma system development', Anaesthesia, 68, pp. 30-39. doi: 10.1111/anae.12049. MacKenzie, E.J., Rivara, F.P., Jurkovich, G.J., Nathens, A.B., Frey, K.P., Egleston, B.L., Salkever, D.S. and Scharfstein, D.O. (2006) 'A national evaluation of the effect of traumacenter care on mortality', New England Journal of Medicine, 354(4), pp. 366-378. Manson, J., Cooper, S., West, A., Foster, E., Cole, E. and Tai, N.R. (2013) 'Major trauma and urban cyclists: physiological status and injury profile', Emerg Med J, 30(1), pp. 32-37. McCullough, A.L., Haycock, J.C., Forward, D.P. and Moran, C.G. (2014) 'Major trauma network in England
', II.Major trauma networks in England, . Morrissey, B.E., Delaney, R.A., Johnstone, A.J., Petrovick, L. and Smith, R.M. (2015) 'Do trauma systems work? A comparison of major trauma outcomes between Aberdeen Royal Infirmary and Massachusetts General Hospital', Injury, 46(1), pp. 150-155. Oestern, H., Garg, B. and Kotwal, P. (2013) 'Trauma Care in India and Germany', Clinical Orthopaedics and Related Research, 471(9), pp. 2869-2877. doi: 10.1007/s11999-013-30352. Shuman, K.M. and Meyers, M.C. (2015) ' The updated trauma system in England ', The Physician and sportsmedicine, 43(3), pp. 317-323. doi: 10.1080/00913847.2015.1050953. Stammers, J., Williams, D., Hunter, J., Vesely, M. and Nielsen, D. (2013) 'The impact of trauma centre designation on open tibial fracture management', Annals of the Royal College of Surgeons of England, 95(3), pp. 184-187. doi: 10.1308/003588413X13511609957416. West Midlands Databook 2017. (2017). [ebook] Birmingham: Birmingham Business school, p.42. Available at: https://www.birmingham.ac.uk/Documents/college-socialsciences/business/research/city-redi/west-midlands-databook-2017.pdf [Accessed 4 Jan. 2018].

Tutor Answer

ProfessorEmily
School: Boston College

Attached.

Running head: MAJOR TRAUMA CENTRES

Major Trauma Centres
Name:
Institution:
Instructor:
Course:
Date:

1

MAJOR TRAUMA CENTRES

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The Research Title

Reducing the mortality rate related to RTAs with respect to the West Midland approaches in
establishing of MTC in the city.

MAJOR TRAUMA CENTRES

3
Abstract

Road traffic accidents (RTAs) are considered as the leading cause of death in the world
for people under the age of 45 years. This high mortality rate has resulted in the establishment
of a new trauma system to reduce the mortality rate due to trauma from RTAs by some of the
developed countries. These systems have led to the development of the Major Trauma Centres
(MTCs), specialist hospitals that treat trauma patients without a necessity for a further transfer
for more advanced treatment. These MTCs have shown a significant reduction in the mortality
rate as a result of trauma. Furthermore, there is no previous study that examines the health
impact of these MTCs due to other trauma injuries.
This study focuses on the MTCs in the West Midland by comparing data from three
MTCs. This comparison is based on data before the establishment of MTCs, after establishment
and operating for one year, and the previous year’s data. The method of collection of data does
not permit the direct contact with the patients, and their data will be coded. Thus, this research
aims to study the effect of MTCs on the reducing mortality rate due to RTAs.

MAJOR TRAUMA CENTRES

4
The Research Topic

Many developing countries suffer from deaths as a result trauma from road traffic
accidents (RTA), that are considered as the leading cause of death in the world for people under
the age of years (Oestern, Garg and Kotwal, 2013). These deaths can be avoided if the
government improved the road safety standards and health service systems. Thus, some of the
developed countries have established new trauma networks to combat trauma injuries,
demonstrating a significant reduction in the mortality rate.
Among these countries is the UK whereby the new trauma network has led to the
development of specialist hospitals called major trauma centres (MTCs). These specialized
health facilities provide all the services that trauma patients could need without a necessity to
transferring them to more advanced health facilities. These MTCs have shown a remarkable
reduction in the mortality rate of trauma injuries (Davenport et al., 2010). Based on the
previous studies, there is a literature gap on the impact of major trauma centres on RTAs apart
from other trauma injuries. In this research, the impact of MTCs on RTAs patients will be
studied using the endpoint of mortality rate. This will illustrate the influence of MTCs in
countries that are affected by the high mortality rate as a result of RTAs.
Literature Review
Major trauma is regarded as the leading cause of death in the UK for people aged under
45 years (Morrissey et al., 2015). It is also the main cause of around 250 million disabilities in
the world yearly. This results in long-term health impact on a patient’s life (Kieffer et al.,
2016). These long-term health impacts are caused by head and spinal cord injuries, resulting in
disabilities on the victim. Both deaths and disabilities caused by trauma from these road
accidents affect countries by decreasing the manpower that could be put to use and improve
the living standards. The one-quarter of the deaths as a result of road traffic accidents could be
prevented if governments upgraded their health services (Lendrum and Lockey, 2013). From a

MAJOR TRAUMA CENTRES

5

wider perspective, the World Health Organization (WHO) estimates that by 2020, the major
trauma will be the leading cause of death in the world (Manson et al., 2013).
Major trauma is defined according to the trauma with Injury Severity Score (ISS) > 15
(Kehoe et al., 2015). ISS is the current universally used scoring system that describes the
severity of the trauma numerically. According to this scoring system, the body is divided into
six regions: head and neck, face, chest, abdomen, extremities, and external. The score is
calculated by the sum of squares of abbreviate injury scale (AIS) for...

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