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Background: Single-centre studies suggest that successive Coronavirus Disease 2019 (COVID-19)-related "lockdown" restrictions in England may have led to significant changes in the characteristics of major trauma patients. There is also evidence from other countries that diversion of intensive care capacity and other healthcare resources to treating patients with COVID-19 may have impacted on outcomes for major trauma patients. We aimed to assess the impact of the COVID-19 pandemic on the number, characteristics, care pathways, and outcomes of major trauma patients presenting to hospitals in England. Methods and findings: We completed an observational cohort study and interrupted time series analysis including all patients eligible for inclusion in England in the national clinical audit for major trauma presenting between 1 January 2017 and 31 of August 2021 (354,202 patients). Demographic characteristics (age, sex, physiology, and injury severity) and clinical pathways of major trauma patients in the first lockdown (17,510 patients) and second lockdown (38,262 patients) were compared to pre-COVID-19 periods in 2018 to 2019 (comparator period 1: 22,243 patients; comparator period 2: 18,099 patients). Discontinuities in trends for weekly estimated excess survival rate were estimated when lockdown measures were introduced using segmented linear regression. The first lockdown had a larger associated reduction in numbers of major trauma patients (−4,733 (21%)) compared to the pre-COVID period than the second lockdown (−2,754 (6.7%)). The largest reductions observed were in numbers of people injured in road traffic collisions excepting cyclists where numbers increased. During the second lockdown, there were increases in the numbers of people injured aged 65 and over (665 (3%)) and 85 and over (828 (9.3%)). In the second week of March 2020, there was a reduction in level of major trauma excess survival rate (−1.71%; 95% CI: −2.76% to −0.66%) associated with the first lockdown. This was followed by a weekly trend of improving survival until the lifting of restrictions in July 2020 (0.25; 95% CI: 0.14 to 0.35). Limitations include eligibility criteria for inclusion to the audit and COVID status of patients not being recorded. Conclusions: This national evaluation of the impact of COVID on major trauma presentations to English hospitals has observed important public health findings: The large reduction in overall numbers injured has been primarily driven by reductions in road traffic collisions, while numbers of older people injured at home increased over the second lockdown. Future research is needed to better understand the initial reduction in likelihood of survival after major trauma observed with the implementation of the first lockdown. Using national registry data for all trauma receiving hospitals in England, Carl Marincowitz and colleagues report the impact of successive COVID lockdowns on the characteristics, care pathways and outcomes of major trauma patients. Author summary: Why was this study done?: Previous studies assessing the impact of COVID lockdowns on major trauma have used data collected at single or a small number of hospitals. There is conflicting evidence regarding whether changes to health services during the pandemic led to worse outcome for patients following major trauma. What did the researchers do and find?: We used national registry data for all trauma-receiving hospitals in England to assess the impact of successive COVID lockdowns on the characteristics, care pathways, and outcomes of major trauma patients. We used a quasi-experimental method that accounted for changes in the characteristics of major trauma patients to identify changes in likelihood of survival when lockdown measures were introduced. We found large reductions in major trauma during both lockdowns, particularly related to road traffic collisions. Reductions were smaller for patients aged over 65. Likelihood of survival following major trauma fell when the lockdown measures were first introduced. Reassuringly, likelihood of survival returned to prelockdown levels over the period of the first lockdown. What do these findings mean?: Falls from standing is the most common cause of major trauma in older adults. Lockdown restrictions appear not to have not have altered likelihood of such trauma. Disruption of services due to COVID restrictions may have reduced likelihood of survival during the initial part of the first COVID wave in England. This study only included trauma patients who attended hospital and met national audit inclusion criteria and COVID status of patients was not included in analysis. [ABSTRACT FROM AUTHOR]

The word 'trauma' describes the disease entity resulting from physical injury. Trauma is one of the leading causes of death worldwide and deaths due to injury look set to increase. As early as the 1970s, it became evident that centralisation of resources and expertise could reduce the mortality rate from serious injury and that organisation of trauma care delivery into formal systems could improve outcome further. Internationally, trauma systems have evolved in various forms, with widespread reports of mortality and functional outcome benefits when major trauma management is delivered in this way. The management of major trauma in England is currently undergoing significant change. The London Trauma System began operating in April 2010 and others throughout England became operational this year. Similar systems exist internationally and continue to be developed. Anaesthetists have been and continue to be involved with all levels of trauma care delivery, from the provision of pre-hospital trauma and retrieval teams, through to chronic pain management and rehabilitation of patients back into society. This review examines the international development of major trauma care delivery and the components of a modern trauma system. [ABSTRACT FROM AUTHOR]

Despite the anti-Spanish thrust of Book Five of Edmund Spenser's The Faerie Queene, the manner in which the principle of equity is applied in the book resembles the Spanish Dominican use of natural law to weigh the ethics of the Spanish conquest of the Americas. In Book Five, the champions Artegall and Britomart face a situation analogous to the Spanish conquest when they confront the Amazon, Radigund, who rules over a city that the narrator characterizes as unnatural. Artegall fails to exercise equity correctly and the result of his failure is his capture and imprisonment by Radigund as well as his eventual liberation by the female knight, Britomart. Britomart's intervention identifies equity as a feminine principle, presumably in order to identify the exercise of equity with Britomart's real-life counterpart, Queen Elizabeth. In the Radigund episode at the center of Book Five, Spenser's poem is caught in a contradiction between his adherence to the principle of "feminized" equity in foreign contexts and his insistence on basic principles of natural law, which were responsible for naturalizing patriarchal gender relations. As a result, one important and available (mis)reading of the book is that the narrative justifies the (Spanish) conquest of England itself and its own "Amazon" queen, Elizabeth, in the interest of restoring a regime based on traditional conceptions of natural law. In this respect, the logic that Book Five follows is similar to that championed by exiled English Catholics, who allied themselves with the Spanish crown against Elizabeth. [ABSTRACT FROM AUTHOR]

In April 2005 the specialist palliative care team at North Tees, Teesside, became the first in the country to be accredited with the University of Teesside School of Health and Social Care award of Excellence in Practice, The Excellence in Practice Accreditation Scheme (EPAS) measures the standard of practice by providing objective data indicating the level of clinical excellence obtained by a team. This article gives the rationale behind the specialist palliative care team choosing to work towards achieving this award along with the key issues, which bad to be addressed within the team. It may help other teams wishing to have some objective measure of their clinical and organizational performance to consider working towards EPAS. [ABSTRACT FROM AUTHOR]

Examines the effects of a conflict between a commitment to natural-law theory and a corresponding commitment to the native English tradition of common law on Renaissance ethnographies in Ireland. Overview of books about the debates on the ethnics and justice of the New World conquests; Difficulties experienced by English administrators in organizing the government and the English presence to bring about subjugation and reform; Differences between the doctrines of natural law and common law; Implications of the failure of Spaniards to conquer Ireland for the freedom of England.

Examines the incidence and origin of vocal cords contamination in trauma patients in London, England. Performance of tracheal intubation; Percentage of patients with gross contamination and gastric contents; Implications of the contamination for prehospital airway management and for the use of laryngeal mask airway.

Information about topics discussed at the London Trauma Conference held at the Royal Geographical Society in London, England in December 4-7, 2012 is presented. Topics of the conference include trauma care, pre-hospital care and major incident management. A symposium hosted by the Norwegian Air Ambulance on air ambulance medicine and cardiac arrest is highlighted.

The article offers information on the 5th London Trauma and Pre-Hospital Care Conference that took place from June 22 to 24 at Royal Geographical Society in London, England. The conference was attended by 400 participants form 14 countries and main topic of discussion was pre-hospital care and major accidents. Also presented were several lectures, keynote addresses and debates on trauma. Additionally, the next conference would held from December 4 to 7, 2012.