You are the paediatric registrar on call at night when the child who presented floppy and unwell via the general practitioner and emergency department earlier in the shift is found to have an intracranial bleed with no explanation as to how this occurred. You are on the paediatric ward, the child having been transferred there directly from scan. This is now a major trauma. If a child has had a significant enough injury to cause an intracranial bleed, is there a possibility that they have suffered an injury elsewhere? How do you manage this patient? Most regional major trauma pathways state that those children who have suffered a major trauma, including because of a non-accidental injury, should be managed as time-critical and transferred by a local team to a tertiary centre for definitive care. However, it was noted and confirmed by audit in one regional critical care transport service, that referrals requesting transfer of major trauma patients were a regular occurrence. Despite measures to publicise
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