This thesis presents work from six papers written by the late Dr Carl McQueen during his time as a National Institute for Health Research Doctoral Research Fellow working at the University of Warwick. It explores how best to improve the outcomes of patients who sustain major trauma in the UK – something McQueen was passionate about. Mobile enhanced care teams can bring the specialist skills usually limited to a hospital to the patient’s side at the point of injury. One of the key specialist interventions such teams can provide is prehospital anaesthesia. In a retrospective observational study from a regional enhanced care team, McQueen showed that prehospital anaesthesia was delivered with a high success rate to patient who sustained major trauma and were unconscious, with or without airway compromise. The decision about when to send an enhanced care team to the scene of an emergency is challenging. Often insufficient information is available about the nature of the victim’s injury or illness to make an informed decision. McQueen showed that it was relatively rare for patients with medical problems or those linked to equestrian incidents to require specialist intervention. McQueen also showed the location of patients requiring enhanced care skills varies by time of day with most incidents at night occurring around cities / large towns. A systematic review of the literature found little evidence to guide decision making for primary dispatch of the enhanced care teams. Despite the paucity of evidence for triage systems to inform dispatch of enhanced care teams, reorganisation of regional trauma services in the West Midlands appears to have improved targeted dispatch of enhanced care teams. Together these papers show the potential for benefit from better co-ordination of enhanced care teams.

This thesis explores the general public s experiences of sport related injury (SRI) as they utilise Sport and Exercise Medicine services in NHS England. It focuses specifically on: the treatment pathways to, and utilisation of, one Sport and Exercise Medicine (SEM) clinic in NHS England; the social and economic costs incurred as a consequence of SRI; and the extent healthcare utilisation and costs coalesce to structure SRI experience. The study employs a qualitative methodology based on a two phase research design that retrospectively maps the pathways of patients (n=19) up until their treatment at the SEM clinic (focusing on social and economic costs ), and prospectively, as a number of patients (n=4) continue their treatment at the SEM clinic, thus illustrating how pathways and costs feed each other in problematic ways. Findings demonstrate that patient pathways to SEM are relatively lengthy and inefficient due to a lack of knowledge of SEM initiatives for SRI treatment amongst both GPs and patients. This leads to indirect referrals, increased workload in primary care and the utilisation of general orthopaedic secondary care services. It further highlights a number of social and economic costs incurred through SRI, such as diminished social wellbeing, increased emotional labour, poor health behaviours and workplace absenteeism, which are exacerbated through inefficient patient pathways and patient dissatisfaction with general orthopaedic treatment. The thesis is the first study to shed light on the pathways of SRI patients in the NHS and the treatment experience of SEM clinics in NHS England. It demonstrates the extent SEM initiatives justified on the basis of improving the efficiency of pathways and satisfaction of treatment for SRI patients could be more effectively implemented and identifies a number of important implications for the future sustainability of physical activity health promotion policy and the wider social and economic productivity of exercising public populations.