Professor of Clinical Traumatology Keith Porter is involved in the treatment of some of University Hospital Birmingham NHS Foundation Trust’s (UHB) most complex injury cases. He trained at St Thomas’ Hospital in London in the 1970s before being jointly appointed at the Birmingham Accident Hospital and Selly Oak Hospital in April 1986. He was awarded a professorship by UHB, the University of Birmingham and the Royal Centre for Defence Medicine in 2005.

The Birmingham Accident Hospital (the “Acci”) was opened on the site of the old Queen’s Hospital on Bath Row, Birmingham, in 1941. It is widely considered to have been the first trauma centre in the world.

When it closed in 1993, its trauma services were eventually transferred to Selly Oak Hospital. In June 2010, trauma was one of the first departments to move to the new Queen Elizabeth Hospital Birmingham (QEHB).

The Acci’s first medical director was Professor William Gissane, who Keith says he looked up to, while training, as one of the “doyens” of trauma surgery: “I always had a desire to be involved in the care of the injured. And as such, my training was geared towards getting a consultant job at the Birmingham Accident Hospital. It was really a place for pioneers of the specialty and it had a national and international reputation.

“Birmingham has always had a high-profile standing for its care of the injured, and a lot of that work has been carried on as the service has moved around the city.

Remembering the Acci

Keith recalls “It was a really wonderful experience working at the Accident Hospital. It was a stand-alone facility, which was perhaps one of its criticisms, but it felt like working in one big family.

“If I had a case, which sometimes we all do, where a patient didn’t survive, it was not uncommon for ward domestics, cleaners or porters to say ‘sorry to hear about your case.’ We often have Accident Hospital reunions and more than 300 people came to the last one. It was really something of an institution within this city.”

Vast improvements in the care of the injured

Many of Professor Porter’s patients are now surviving injuries that they would not have in years past.

He says that the improvements to the trauma service have come across disciplines – from advances in pre-hospital care, to lessons learnt from the care of complex military battle-injuries: “Undoubtedly, patients are surviving injuries that they were not surviving before. Some of the key changes equate to the introduction of paramedics in pre-hospital care and the use of doctors in Air Ambulance crews.

“The speed that a patient can be delivered to hospital – and to the hospital that is most appropriate for their treatment – has also been recognized as vitally important.

“For example, if you’ve got a bad head injury you could need a hospital with a neurosurgical department, and if you’ve got an awful burn then you’d need to come to a hospital such as this one [Selly Oak] which has a specialist burns unit and burns surgeons.

“And of course our colleagues in emergency medicine have similarly gained more expertise in resuscitation and we now have a much more holistic approach to how we manage these injuries.”

Lessons learnt from the military experience

Keith said: “We’ve learnt lessons. And an awful lot of lessons for trauma management relate to translated messages from the military experience.

“Every clinical action should really be supported by an evidence base. In some aspects, that doesn’t always exist. But we are constantly modifying our practice based on the contemporary evidence base.

“In a lot of our work today, especially with the military, we are seeing some very complex wounds and we are having to institute management that isn’t in the textbooks. And that’s because the wounds themselves are not in the conventional textbooks.

“So I think we’re very much at the forefront of how such wounds are managed. The experience here at UHB is absolutely unique in the UK.

“A lot of the improved skill-base and wider knowledge is now being implemented in civilian practice. This means we’re now giving a much better level of service.”

The best in care for injured soldiers

“From my own personal point of view, I’ve always had a commitment to trauma care in its totality and trauma surgery. I have been fortunate enough to have had increasing involvement with the treatment of military personnel.

“I was involved in looking after patients in the first Gulf War and without a doubt the whole aspect of military care, from the point of wounding to ultimate discharge and rehabilitation, is now so much better.

“Our patients come back here now, about 36 hours post-injury, invariably in the best possible physiological condition they can be.

“In many cases, the complexities of their injuries, compared with the first Gulf war, are so much greater – and many of them are surviving.

“I think that is truly a reflection of what the military and UHB have to offer.”

The impact of the new hospital

The new Queen Elizabeth Hospital Birmingham, which treated its first patient in June 2010, will be one of the most up-to-date medical facilities in the world.

For Keith, and the rest of the Trauma Team, this is an exciting time for the development of their service: “With the opening of the new hospital, UHB is going to be the major trauma centre for Birmingham and a lot of the surrounding conurbation.

“Single-site working will offer considerable advantages. Some of our patients involve support from a number of services. To give an example: neurosurgery and cardiothoracic surgery are currently based at the Queen Elizabeth Hospital and while we can always get surgical support when we need it in a hurry, it will be very desirable to be on a single site.

“I think, truly, the new hospital has the ability to be a world leader in many respects, not just in trauma.

“For instance, [UHB] is already well known for its expertise in areas such as cancer. But as we embrace single-site working and the multi-disciplinary support then I think the lead decisions will be taken at consultant level and I think this will have a major impact on patient outcomes.

“Let alone the fact that we’ll have much better facilities in terms of their functionality; particularly the wards and theatres.”

Treasured experiences, new ventures

“As I get older, I see an increasing number of young doctors who have worked at the Accident Hospital, at the General and at Selly Oak who are now consultants in their own right.

“Without exception, they all embrace the value of the experience they’ve had from working in this trust and how the service given to patients isn’t mirrored at any other institution in the country.

“For me, that is something I treasure quite fondly. Along with, of course, the fact that we have a very robust multi-disciplinary support service: physios, occupational therapists and our nursing colleagues. It is really an increasingly bigger football team, if you like, and we are certainly scoring some goals.”