Table 2 Summary of the management pathway

Prior to hospital

Paramedic team:

 Contacts trauma coordinator en route by phone

 Obtains intravenous access

 Administers appropriate analgesia

 Performs ECG

On arrival at hospital

Trauma coordinator arrives at ambulance bay and receives standardised handover:

 Identifies emergent medical issues

 Gathers key social information essential for the discharge process

Prior to X-ray

Trauma coordinator:

 Completes X-ray request form

 Scores pain level and gives analgesia

 Starts pathway paperwork, including:

   MRSA risk

   Diarrhoea and vomiting assessment

 Refers to emergency department team if there are any medical concerns

After X-ray

 Fracture confirmed by on-call orthopaedic consultant using picture archiving and communication system (PACS)

 Patient moved to optimisation area

In optimisation area (bay in recovery suite of theatre complex)

 Local anaesthetic block (fascia iliaca block) performed by trauma co-ordinator

 Review performed by operating surgeon and anaesthetist

 Review done by intensivist if required

 Prepared for surgery on trauma list or elective list (where space available)

 If no surgical time available, transferred to ward

Following surgery

 Transferred to ward