Section 2: At the hospital

Why is my loved one in this hospital?

When someone is seriously injured in a road crash, the emergency services decide which hospital to take them to.

In some cases, this is not the closest hospital. It may be decided that care is provided best by a hospital further away. A person with very serious injuries may be taken to a Major Trauma Centre (MTC) for treatment. Major Trauma Centres are specialist hospitals that have all of the facilities needed to treat severe injuries.

If you know something important about the medical history of the injured person that might affect decisions about their care, tell medical staff as soon as possible. For example, if the injured person has a medical condition, allergies, or is on medication.

Why is my loved one in this hospital department?

An injured person may be cared for in a specialist unit, for example a unit for brain injury, spinal injury or burns.

Some seriously injured people are cared for in an intensive care unit (ICU).

An ICU is for patients who need constant, close monitoring and help to support bodily functions, such as breathing or heart rate. ICUs have specialist doctors, medicine, and equipment.

An ICU is sometimes called an intensive therapy unit or critical care unit.

For more information about ICUs, go to the charity icusteps.org or go to www.nhs.uk and search for ‘intensive care’.

Sometimes, people injured in road crashes have more than one injury, and in some cases medical decisions are made about which injuries to care for first, and where this should happen.

Sometimes, an injured person may be transferred to a different hospital, depending on care they need at a particular time.

If you are not sure why your loved one has been taken to a particular hospital, or part of a hospital, you can ask to talk to hospital staff.

What treatment is being given to my loved one?

Medical staff will do their best to talk with family members, but sometimes it can be hard to understand care a loved one is receiving, for example if:

• injuries are life-threatening and medical care must happen fast
• there is more than one injury
• an injured person’s medical needs change quickly.

You may find it helpful to say to medical staff:

• “When is a good time to explain what is happening?”
• “I didn't understand something. When can I talk to someone?”
• “I know I didn't have questions before, but I do now. When can I ask them?”

It can help to write down questions, so you don't forget to ask them.

Consent to treatment

Decisions should be made with the injured person’s consent. However, this requires a person to have ‘capacity’. Capacity means the ability to understand information, make an informed decision, and communicate that decision.

Often, a seriously injured person does not have capacity. They may be unconscious, or impaired by strong medicines given to them. In that case, medical staff will make decisions for them.

When making decisions about treatment, medical staff should consider:

• what the injured person would be most likely to want
• whether a treatment could be delayed until the patient has capacity.

If an injured person does not have capacity, family and friends can help communicate the views or beliefs of that person to medical staff. If an injured person is a child aged under 16, consent to treatment may be given by their parent or guardian, or in some cases by the child themselves.

Talking to an injured person

As well as causing physical injuries, a road crash can cause shock and distress. If an injured person is conscious, and you are visiting them or talking with them by phone, you may be able to help them feel:

• safer, and reassured they are getting medical attention
• supported, by telling them you care
• calm, by staying calm yourself
• informed, by helping them understand what is happening
• involved, by listening to what they say and helping them get what they need, for example water or more pain relief.

Sometimes it is not possible to talk to a seriously injured person because they are unconscious, or receiving treatment, or visiting is not allowed for a particular reason, such as infection.

Looking after your own needs

Coping when someone is in hospital can be very challenging if you are a family member or friend. You, or others, may be suffering from significant shock and distress, and experiencing a range of emotions and reactions. Different people react in different ways at different times. You may feel exhausted.

It is important to look after your emotional and physical welfare, and, if you are part of a family, to look after each other too. Remember to:

• eat regularly, and drink water or have comforting hot drinks
• stay warm, and get sleep when you can
• seek support, and support each other.

If you were also in the crash, and have minor injuries, it is important they are treated too. Make sure you receive any medical attention you need.

If a child is injured and conscious, or a child has a family member or close friend in hospital, it is important to provide the love and support they need.

Children’s needs are often the same as adults’ needs. They need to feel safe, supported, calm, informed and involved.

Give children honest, short answers, using language they know and can understand easily.

Try not to give too much information at once. Give them a chance to ask questions.

The charity ICU Steps provides an activity book for children who are visiting a relative in an ICU. To download, go to icusteps.org

Help for families right now

If you need emotional support for parents, children or young people, or help with arranging care for children, or any other issue affecting a family, contact the National Road Victim Service.

We can put you in touch with specialist organisations that help care for families.

Help for families if also bereaved

Some children and young people affected by serious injury following a road crash have also been bereaved in the same road crash. If so, the National Road Victim Service can help get you specialist bereavement support and help.

Some seriously injured people need to stay in hospital much longer than other injured people. This could be because:

• they need life-sustaining treatment, for example help getting nutrition through a feeding tube, or dialysis to help kidneys work, or a ventilator to help with breathing
• they need other kinds of ongoing medical care due to the complexity of their injuries, for example several operations.

If someone is in hospital for a long time, you may have additional challenges. This could include:

• worry and uncertainty about your loved one’s health
• financial challenges, for example if family income is affected
• challenges working or challenges at home
• transport challenges, if you live a long way from the hospital.

If a child or young person is in hospital for a long time, their education may continue while they are in hospital.

The Patient Advice and Liaison Servce (PALS) offers confidential advice, support and information on health-related matters. They provide a point of contact in hospitals for patients, their families and their carers. For more information, go to www.nhs.uk and search for 'patient advice'.

Whatever your challenges, contact the National Road Victim Service for help and support, including finding other agencies that can support you at this time.

When someone is discharged from hospital it can feel like a big moment. For some injured people, the future holds a rapid recovery. However, for others, the future looks very different. For some injured people, it can include living with chronic pain, or more operations, treatments or therapies, one or more disability, or other changes. It can be difficult to know all the issues that might be faced in the future.

Before leaving hospital, you should be given a copy of a hospital discharge letter. This is a letter for your GP that helps them understand:

• injuries sustained and hospital treatment given
• any follow-up medical appointments needed
• medication prescribed.

Before leaving hospital, ask to meet medical staff to help you understand:

• the contents of the hospital discharge letter
• reasons for medication and possible reactions to it
• what future appointments are for, and what will happen in them
• the possible long-term effects of injuries
• how education will be arranged, if a child or young person is leaving hospital
• what else is going to happen next, to support an injured person’s health and wellbeing, and who will provide that support.

If follow-up care is likely to be needed, or there is a new disability, it is particularly important that you leave hospital with an understanding of specialist health care or social care that is available to you, and how to contact people providing this care.

If you have left hospital and there is something you don’t understand, make an appointment with your GP. They are your community health representative. Your GP can contact the hospital and ask for more information about what happens next and why. They can also seek help from other health care or social care professionals.

If you feel you are not getting the help you need, contact the National Road Victim Service.