Post on 22-Apr-2020
5 – 7 October 2018Parmelia Hilton
Perth, Western Australia
traumaconference.com.au
Program Book
GOLD SPONSOR
T R A U M A 2 0 1 8 C O N F E R E N C E P R O G R A M A N D A B S T R A C T B O O K
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Acknowledgements
The Trauma 2018 Organising Committee would like to thank the following organisations who at the time of print have given their support:
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Welcome
I have great pleasure in welcoming you to Trauma 2018, the 22nd Annual Scientific Meeting of the Australasian Trauma Society being held from 5-7 October 2018 at the Parmelia Hilton Hotel in Perth, WA. This meeting has been organised in close collaboration with the Perth Trauma Symposium Group. The theme of the meeting is “Getting the basics right and embracing evidence-based change”. The Organising and Scientific Committees have decided on a program that would provide clinical updates on current trauma management as well as what is on the horizon for future trauma research.
Our outstanding invited international speakers include Professor Fiona Lecky (UK) and Associate Professor David Zonies (USA).
Professor Lecky is an Emergency Physician and trauma researcher based in Sheffield, UK. She is the Research Director of the UK Trauma Audit and Research Network (TARN). She has a number of research interests including the evaluation and improvement of trauma care systems as well as the optimal management of acute brain injury and mass casualties.
Associate Professor Zonies is the Director of Surgical Critical Care and the extracorporeal life support program at the Oregon Health & Science University, Oregon, USA. He is also a Colonel in the U.S. Air Force Reserve. His areas of research include trauma/critical care outcomes, global health injury epidemiology, advanced extracorporeal therapies for trauma, bioethics and palliative care.
We also have our usual invited local trauma experts (medical, nursing and Allied Health professionals) who will provide you with valuable updates on both current trauma management and recent Australasian trauma research activities. There will also be a number of free paper sessions which will give our local trauma researchers an opportunity to showcase the excellent research currently being undertaken in Australasian metropolitan and regional Trauma Centres.
There will also be a number of pre-conference workshops which will be held on 4th October 2018, which will include airway management, ultrasound, nursing quality and data management, trauma research and Allied Health topics.
The social events, including the Welcome Reception and Conference Dinner, will provide ample opportunity to mix with your colleagues in a relaxing and friendly West Australasian atmosphere.
I encourage you to attend what will be an excellent meeting both from an educational and social perspective. And, if you have time, I recommend that you explore our beautiful capital city in the west and further afield in this very large and diverse state.
Dr Anthony Joseph Chair Organising and Scientific Committees Trauma 2018
CONTACT
For all enquiries please contact:Trauma 2018 SecretariatC/ - The Association Specialists Pty LtdPO Box 576, Crows Nest NSW 1585, AUSTRALIATel: +61 2 9431 8600Fax: +61 2 9431 8677trauma2018@theassociationspecialists.com.auwww.traumaconference.com.au
For all enquiries please contact:Australasian Trauma SocietyPO Box 576, Crows Nest NSW 1585, AUSTRALIATel: +61 2 9431 8668Fax: +61 2 9431 8677ats@theassociationspecialists.com.auwww.traumasociety.com.au
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Organising Committee
• Ms Maxine Burrell, Trauma Program Manager, Trauma Services, Royal Perth Hospital, Perth, WA, Australia
• Dr Ian Civil, Clinical Leader, Major Trauma National Clinical Network and Professor of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
• Alicia Jackson, CNC Trauma Service, Royal North Shore Hospital, Sydney, NSW, Australia
• Dr Anthony Joseph, Director of Trauma (Emergency) and Senior Staff Specialist, Emergency Department, Royal North Shore Hospital, and A/Professor Discipline of Emergency Medicine, The University of Sydney, Sydney, NSW, Australia
• Ms Helen Jowett, Trauma Service Manager, The Royal Children’s Hospital, Melbourne, VIC, Australia
• Dr Kate Martin, General and Trauma Surgeon, The Alfred Hospital, Melbourne, VIC, Australia
• Ms Trish McDougall, RACS Trauma Quality Improvement Committee Member, Melbourne, VIC, Australia
• Prof. Michael Parr, Director, Intensive Care Unit, Liverpool Hospital, and A/Professor of Critical Care, South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
• Dr Sudhakar Rao, Director of Trauma, Trauma Services, Royal Perth Hospital, Perth, WA, Australia
• Colonel Michael Reade, Professor of Military Surgery & Medicine SOMCentral, Anaesthesiology and Critical Care, Royal Brisbane and Women’s Hospital, Faculty of Medicine and Biomedical Sciences, Brisbane, QLD, Australia
• Dr Michelle Johnston, Emergency Physician, Royal Perth Hospital, Perth, WA, Australia
Scientific Committee
• Adj. A/Prof. John Buchanan, Area Director of Allied Health and Health Sciences, East Metropolitan Health Service, Director of Allied Health, Royal Perth Bentley Group, Perth, WA, Australia
• Ms Maxine Burrell, Trauma Program Manager, Trauma Services, Royal Perth Hospital, Perth, WA, Australia
• Dr Ian Civil, Clinical Leader, Major Trauma National Clinical Network and Professor of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
• Alicia Jackson, CNC Trauma Service, Royal North Shore Hospital, Sydney, NSW, Australia
• Dr Anthony Joseph, Director of Trauma (Emergency) and Senior Staff Specialist, Emergency Department, Royal North Shore Hospital, and A/Professor Discipline of Emergency Medicine, The University of Sydney, Sydney, NSW, Australia
• Ms Helen Jowett, Trauma Service Manager, The Royal Children’s Hospital, Melbourne, VIC, Australia
• Dr Kate Martin, General and Trauma Surgeon, The Alfred Hospital, Melbourne, VIC, Australia
• Ms Trish McDougall, RACS Trauma Quality Improvement Committee Member, Melbourne, VIC, Australia
• Prof. Michael Parr, Director, Intensive Care Unit, Liverpool Hospital, and A/Professor of Critical Care, South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
• Dr Sudhakar Rao, Director of Trauma, Trauma Services, Royal Perth Hospital, Perth, WA, Australia
• Colonel Michael Reade, Professor of Military Surgery & Medicine SOMCentral, Anaesthesiology and Critical Care, Royal Brisbane and Women’s Hospital, Faculty of Medicine and Biomedical Sciences, Brisbane, QLD, Australia
Organising and Scientific Committees Trauma 2018
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Associate Professor David Zonies
Associate Professor of Surgery,
Oregon Health & Science
University, Oregon, United States
of America. Associate Professor
David Zonies is a trauma and emergency surgeon at
the Oregon Health & Science University (OHSU). He is
an associate professor of surgery in the OHSU School
of Medicine. A/Prof. Zonies is the director of surgical
critical care and the extracorporeal life support program
at OHSU. Additionally, he is a Colonel in the U.S. Air Force
Reserve with over a decade of active duty service and
multiple overseas assignments. His areas of research
include trauma/critical care outcomes, global health injury
epidemiology, advanced extracorporeal therapies for
trauma, aerospace physiology in critical illness, biotethics,
and palliative care.
Professor Fiona Lecky
Professor Fiona Lecky is Clinical
Professor of Emergency Medicine
in ScHARR (University of Sheffield),
Honorary Emergency Medicine
Consultant at Salford Royal,
and holds an Honorary University of Manchester Chair
as Research Director of the Trauma Audit and Research
Network (TARN). She recently chaired the 2014 NICE
Head Injury Guideline update. Her major research interest
has been the evaluation and improvement of trauma
care systems using TARN and other data sources using
risk adjusted modelling of early mortality, comparative
effectiveness research techniques and trials of complex
interventions. These techniques have identified the
importance of traumatic brain injury (TBI) as the major cause
of death in hospitalised trauma victims and that specialised
neuroscience care was vital for reducing early mortality.
Ms Sarah Adams, CNC Trauma, Sydney Children’s Hospital, Sydney, New South Wales
Dr Paul Bailey, Clinical Services Director, St John Ambulance, Perth, Western Australia
Dr Paul Barnes, Head of the Risk & Resilience Program, Australian Strategic Policy Institute, Canberra, Australian Capital Territory and visiting Associate Professor, Torrens Resilience Institute at Flinders University, Adelaide, South Australia
Dr Savitha Bhagvan, Trauma Consultant, Auckland City Hospital, Auckland, New Zealand
Mr Iain Cameron, Acting Commissioner of Road Safety, Road Safety Commission (WA) and Chair, Road Safety Council (WA), Perth, Western Australia
Dr Don Campbell, Emergency Department Consultant and Deputy Director of Trauma Service, Trauma Service, Gold Coast Hospital and Health Service, Gold Coast, Queensland
Mr Steve Carpenter, Manager Prosthetic & Orthotic Service, Rehabilitation Technology Unit, Royal Perth and Fiona Stanley Hospitals, Perth, Western Australia
Lieutenant Colonel Anthony Chambers, Commanding Officer 3rd Health Support Battalion Australian Army and Head of Dept of General Surgery, St Vincent’s Hospital, Sydney, New South Wales
Dr Ian Civil, Co-Director, Trauma Services, Auckland City Hospital, and A/Professor of Surgery, The University of Auckland, Auckland, New Zealand
Ms Fiona Coll, Senior Physiotherapist, State Major Trauma Unit, Royal Perth Hospital, Perth, Western Australia
Dr Rebecca Cooksey, Paediatric Surgeon, Co-Director, Paediatric Major Trauma Service, Women’s and Children’s Health Network, Adelaide, South Australia
Ms Caroline Cordy-Hedge, Nurse Practitioner, WA Country Health, Western Australia
Ms Deb Crawley, Senior Physiotherapist, Balance and Vestibular Physiotherapy Service, Royal Perth Hospital, and Senior Physiotherapist, Perth Dizziness and Balance Clinic, Perth, Western Australia
Keynote Speakers
Invited Speakers
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Invited Speakers continued
Dr John Crozier, Surgeon, Liverpool Hospital, Sydney, New South Wales
Mr David Dillon, Consultant Spinal Surgeon, WA State Spinal Unit, Royal Perth & Perth Childrens Hospitals, Perth, Western Australia
Mr Carlo Divita, Senior Occupational Therapist, State Acquired Brain Injury Rehabilitation Service, Fiona Stanley Hospital, Murdoch, Western Australia
Prof. Sarah Dunlop, Professor Sarah Dunlop, Head, School of Biological Sciences, The University of Western Australia, Perth, Western Australia
A/Prof. Dan Ellis, Acting Director of Trauma, Royal Adelaide Hospital, Adelaide, South Australia
Prof. Daniel Fatovich, Emergency Physician, Director of Research Royal Perth Hospital and Head, Centre for Clinical Research in Emergency Medicine, Harry Perkins Institute of Medical Research University of Western Australia, Perth, Western Australia
Prof. Mark Fitzgerald, Director, Trauma Services, The Alfred, Melbourne, Victoria
Prof. Melinda Fitzgerald, Professor of Neurotrauma, Curtin Health Innovation Research Institute, Curtin University, and the Perron Institute for Neurological and Translational Science, Ralph and Patricia Sarich Neuroscience Research Institute Building, Nedlands, Western Australia
Dr James Flynn, Emergency Physician, Perth Children’s Hospital and Royal Perth Hospital, Perth, Western Australia
Mr David Ford, Course Co-ordinator Post Graduate Paramedicine, School of Medical and Health Science, Edith Cowan University, Joondalup, Western Australia
Dr Mark Friedericksen, Consultant, Emergency Department and Trauma Service, Auckland City Hospital, Auckland, New Zealand
Dr Kerry Gunn, Deputy Clinical Director (Perioperative), Department of Anaesthesia and Perioperative Medicine, Auckland City Hospital, Senior Lecturer, Dept of Anesthesiology, University of Auckland, Auckland, New Zealand
Dr Delia Hendrie, Senior Research Fellow, Centre for Population Health Research, Curtin University, Bentley, Western Australia
Prof. Andrew Holland, Senior Paediatric Surgeon, The Children’s Hospital at Westmead and Professor of Paediatric Surgery, The Children’s Hospital at Westmead Clinical School, The University of Sydney, Sydney, New South Wales
Prof. Stephen Honeybul, Consultant Neurosurgeon, Department of Neurosurgery, Sir Charles Gairdner Hospital and Royal Perth Hospital, Perth, Western Australia
Dr Andrew Hooper, Acting Director of Medical Services, Royal Flying Doctor Service Western Operations, Western Australia
Dr Anthony Joseph, Senior Staff Specialist, Emergency Department and Director of Trauma, Royal North Shore Hospital and Clinical Associate Professor, Discipline of Emergency Medicine, Faculty of Medicine, University of Sydney, Sydney, New South Wales
Ms Belinda Kennedy, Project Manager NSW Paediatric Trauma Project, The University of Sydney, Sydney, New South Wales
A/Prof. Bridget Kool, Associate Dean (Academic), Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
Mr Tony Lock, Director, Non-Technical Skills Training, Royal Perth Bentley Group and Reserve Squadron Leader Pilot, RAAF, Perth, Western Australia
Dr Kate Martin, General and Trauma Surgeon, The Alfred, Melbourne, Victoria
A/Prof. Sally McCarthy, Medical Director, Emergency Care Institute NSW ACI, Chatswood, New South Wales
Dr Rory McPherson, Interventional Diagnostic Radiologist, Royal Perth Hospital, Perth, Western Australia
Prof. Mark Midwinter, School Biomedical Sciences, University of Queensland and Jamieson Trauma Institute, Royal Brisbane and Women’s Hospital, St Lucia, Queensland
A/Prof. David Mountain, Head of Emergency, Sir Charles Gairdner Hospital and Clinical Academic, University of Western Australia, Perth, Western Australia
Mr Craig Newland, Technical Director, Australian Automobile Association, Canberra, Australian Capital Territory
Dr Alex O’Beirne, Orthopaedic Surgeon, Perth, Western Australia
Dr Rebekah Ogilvie, Clinical Assistant Professor, University of Canberra and Trauma Nurse Practitioner ACT Trauma Service, Canberra, Australian Capital Territory
Mr Derek Parks, Director Aviation Services, Department of Fire and Emergency Services, Perth, Western Australia
Prof. Michael Parr, Director, Intensive Care Unit, Liverpool Hospital, University of New South Wales, Sydney, New South Wales
Dr Tim Phillips, Consultant Interventional Neuroradiologist, Neurological Intervention & Imaging Service of Western Australia, Perth, Western Australia
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Dr Sudhakar Rao, Director of Trauma, Trauma Services, Royal Perth Hospital, Perth, Western Australia
Colonel Michael Reade, Defence Professor of Military Medicine and Surgery, Australian Defence Force and University of Queensland, Brisbane, Queensland
Mr Alec Ring, Physiotherapist, Academic Medical Centre, Clin. Senior Lecturer, School of Medicine, University of Western Australia, Adj Research Fellows, IIID, Murdoch University & School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia
Dr Tony Robins, Executive Director Medical Services, WA Country Health Service, Perth, Western Australia
Ms Lisa Rossiter, Senior Manager Strategic Interventions, New Zealand Transport Agency, Wellington, New Zealand
Mr Warren Sharpe, Director Infrastructure Services, Eurobodalla Shire Council, Moruya, New South Wales
Dr Tony Smith, Medical Director, St John, Auckland, New Zealand
Major Slavko Tokanovic, Australian Defence Force, Perth, Western Australia
Dr Warwick Teague, Director, Trauma Service, The Royal Children’s Hospital, Melbourne, Victoria
Ms Jess Tearne, Clinical Psychologist, State Major Trauma Unit, Royal Perth Hospital, Perth, Western Australia
Prof. Dinesh Varma, Acting Program Director of Radiology, Head of Emergency & Trauma Radiology, The Alfred Health & Monash University, Melbourne, Victoria
Dr Dieter Weber, Consultant Trauma and General Surgeon, Royal Perth Hospital, Perth, Western Australia
Dr Nicole Williams, Director (Research and Education) Paediatric Major Trauma Service, Women’s and Children’s Hospital, and Associate Professor, Centre for Orthopaedic and Trauma Research, University of Adelaide, Adelaide, South Australia
Prof. Fiona Wood, Director of the Burns Service of WA and Director of the Burn Injury Research Unit University of Western Australia, Perth, Western Australia
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Thursday 4 October 2018Parmelia Hilton Perth
0900-1700 Nursing Quality Improvement and Data Management Forum Fremantle Room
0900-1200 Allied Health and Health Science Workshop Stirling Room
0900-1200 Trauma Ultrasound Workshop Karri Room
1400-1545 Emergency Airway Management Workshop Stirling Room
1400-1700 Trauma Research Workshop Karri Room
1700-1900 Injury Reviewer Workshop and Reception Karri Room
Friday 5 October 2018Parmelia Hilton Perth
0800-1000 Opening Plenary Session Argyle Ballroom
1000-1030 Morning Tea Swan Room
1030-1230 Concurrent Session 1 - Trauma Conundrums Argyle Ballroom
1030-1230 Concurrent Session 2 - Trauma Radiology Stirling Room
1030-1230 Concurrent Session 3 - Free Papers - Acute Care Karri Room
1230-1330 Lunch Swan Room
1230-1330 Australasian Trauma Society - Annual General Meeting Argyle Ballroom
1330-1530 Plenary Session 2 - Trauma Outcomes Argyle Ballroom
1530-1600 Afternoon Tea Swan Room
1600-1800 Concurrent Session 4 - Trauma Education Argyle Ballroom
1600-1800 Concurrent Session 5 - Military Trauma Stirling Room
1600-1800 Concurrent Session 6 - Pre Hospital Session Karri Room
1800-2000 Welcome Reception Swan Room
Saturday 6 October 2018Parmelia Hilton Perth
0700-0825 Visco-elastic Monitoring (TEG/ROTEM) in Trauma Bleeding Workshop Stirling Room
0830-1030 Plenary Session 3 - Mass Casualties Argyle Ballroom
1030-1100 Morning Tea Swan Room
1100-1230 Concurrent Session 7 - Clinical Updates Argyle Ballroom
1100-1230 Concurrent Session 8 - Rural Trauma Stirling Room
1100-1230 Concurrent Session 9 - Paediatric Trauma Karri Room
1230-1330 Lunch Swan Room
1330-1500 Plenary Session 4 - National Road Safety Strategy Argyle Ballroom
1500-1530 Afternoon Tea Swan Room
1530-1730 Concurrent Session 10 - Innovations in Trauma Argyle Ballroom
1530-1700 Concurrent Session 11 - Allied Health and Health Science Session Stirling Room
1530-1730 Concurrent Session 12 - Free Papers - Outcomes Karri Room
1930-2400 Conference Dinner Argyle Ballroom
Sunday 7 October 2018Parmelia Hilton Perth
0900-1000 Plenary Session 5 - Best Papers of 2017/18 Argyle Ballroom
1000-1030 Morning Tea Pre-Event Area
1030-1200 Plenary Session 6 - Future of Trauma Care Panel Session and Close of Meeting Argyle Ballroom
Program at a glance
*Program is subject to change
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Friday 5 October 20180800-1000
Opening Plenary Session Argyle Ballroom Chair: Prof. Michael Parr (President ATS)
0800-0810 Welcome to country Official opening Hon. Michelle Roberts MLA Minister for Police and Road Safety
0810-0840 Traumatic brain injury and how to optimise outcomes Prof. Fiona Lecky
0840-0910 The place of ECMO in acute trauma resuscitation A/Prof. David Zonies
0910-0940 The current role of decompressive craniectomy: Based on the current evidence and ethical practice Prof. Stephen Honeybul
0940-1000 Predicting outcomes following mild traumatic brain injury Prof. Melinda Fitzgerald
1000-1030 Morning Tea Swan Room
1030-1230 Concurrent Session 1 - Trauma Conundrums Argyle Ballroom Chair: Dr Kate Martin
1030-1230 Concurrent Session 2 - Trauma Radiology Stirling Room Chair: Dr Tony Joseph
1030-1230 Concurrent Session 3 - Free Papers - Acute Care Karri Room Chair: Ms Helen Jowett and Prof. Michael Parr
1030-1050 Elderly trauma and optimal outcomes Prof. Fiona Lecky
1030-1050 Spinal radiology controversies A/Prof. Dinesh Varma
1030-1045 Fibrinogen concentrate vs. cryoprecipitate in severe traumatic haemorrhage in children: A pilot randomised controlled trial Dr Don Campbell and Elizabeth Wake
1050-1110 Palliative care in trauma: A new sub-specialty? A/Prof. David Zonies
1050-1110 Interventional radiology in trauma: The new “surgery” Dr Rory McPherson
1045-1100 Pelvic binder placement - tightening it up Dr Chris Bong
1110-1130 Venous thromboembolism in trauma A/Prof. David Mountain
1110-1130 Optimal abdominal imaging in trauma Prof Dinesh Varma
1100-1115 ‘To scan or not to scan’ in the trauma setting – a retrospective study Dr Teresa Holm
1130-1150 Is it still necessary to immobilise the neck prior to radiology in the acute trauma patient? Dr Tony Smith
1130-1150 Neurointerventional radiology: New frontiers Dr Tim Phillips
1115-1130 Identifying areas for improvement in paediatric trauma care using peer-review Ms Belinda Kennedy
1130-1145 Refinement of an evidence-informed care bundle for blunt chest injury Ms Sarah Kourouche
1150-1210 What is the right size for a chest tube? Does size matter? Dr Savitha Bhagvan
1150-1210 CT pan scans: What are the dangers? Prof. Dinesh Varma
1145-1200 Four quadrant decompressive craniotomy vs conventional decompressive craniectomy for traumatic brain injury: A randomized controlled trial Dr Siddharth Vankipuram
1200-1215 A level one Australasian trauma centre’s five year experience of traumatic urethral injuries Dr Jan Fletcher
1210-1230 Penetrating neck trauma: Investigate or explore? Dr Sudhakar Rao
1210-1230 Questions 1215-1230 The rise and changing nature of thoracic injuries among the major trauma population Dr Noha Ferrah
1230-1330 Lunch Swan Room
1230-1330 Australasian Trauma Society - Annual General Meeting Argyle Ballroom
Program
*Program is subject to change
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1330-1530 Plenary Session 2 - Trauma Outcomes Argyle Ballroom Chair: Dr Ian Civil
1330-1350 The TARN evaluation of the UK NHS trauma system after reorganisation Prof. Fiona Lecky
1350-1410 The burden of injury in the developing world: Are there tangible solutions A/Prof. David Zonies
1410-1430 Clinical trials for spinal cord injury Prof. Sarah Dunlop
1430-1450 The increasing cost of injury: What can be done? Dr Delia Hendrie
1450-1510 The New Zealand pre-hospital fatal injury outcome study A/Prof. Bridget Kool
1510-1530 The Australian and NZ National Trauma Registry: What can it achieve? Prof. Mark Fitzgerald
1530-1600 Afternoon Tea Swan Room
1600-1800 Concurrent Session 4 - Trauma Education Argyle Ballroom Chair: Dr Tony Joseph
1600-1800 Concurrent Session 5 - Military Trauma Stirling Room Chair: Dr John Crozier
1600-1800 Concurrent Session 6 - Pre Hospital Karri Room Chair: Dr Sudhakar Rao
1600-1620 DSTC / DATC: What is old is new again? Dr Ian Civil
1600-1620 Trauma and critical care outcomes: What we can learn from the military? A/Prof. David Zonies
1600-1620 When guidelines don’t help - a new approach to traumatic cardiac arrest in WA Dr Paul Bailey
1620-1640 10TH edition EMST: An update Dr Kate Martin
1620-1640 Military trauma: What might not translate into civilian practice Colonel Michael Reade
1620-1640 Capability development framework for aeromedical rescue Mr Derek Parks
1640-1700 Trauma critical incident review Prof. Michael Parr
1640-1700 Building and evaluating the military trauma system Lieutenant Colonel Anthony Chambers
1640-1700 The evolution of pre hospital care Mr David Ford
1700-1720 Trauma case management: How to train for it? Dr Rebekah Ogilvie
1700-1720 How to prepare for the unexpected in combat surgical emergencies Prof. Mark Midwinter
1700-1720 Aeromedical Trauma retrieval in the largest state Dr Andrew Hooper
1720-1740 Is there a role for simulation in Trauma training Mr Tony Lock
1720-1740 The art of tactical medicine Major Slavko Tokanovic
1720-1740 War and peace – lessons from the battlespace Dr Tony Robins
1740-1800 Question time 1740-1800 Question time 1740-1800 Panel Session
1800-2000 Welcome Reception Swan Room
Saturday 6 October 20180700-0825 Visco-elastic Monitoring (TEG/ROTEM) in Trauma Bleeding Workshop
Stirling Room Dr Kerry Gunn and Dr Ross Baker
0830-1030
Plenary Session 3 - Mass Casualties Argyle Ballroom Chair: Prof. Michael Parr
0830-0850 The Manchester area bombing and lessons learnt Prof. Fiona Lecky
0850-0910 Injuries due to explosive devices: A review Prof. Mark Midwinter
0910-0930 Nerve agents: An update Colonel Michael Reade
0930-0950 Challenges in designing disaster response capacity for major medical emergencies Dr Paul Barnes
*Program is subject to change
Program continued
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*Program is subject to change
0830-1030
Plenary Session 3 - Mass Casualties Argyle Ballroom Chair: Prof. Michael Parr
0950-1010 Psychological recovery after natural disasters Ms Jess Tearne
1010-1030 Question time
1030-1100 Morning Tea Swan Room
1100-1230 Concurrent Session 7 - Clinical Updates Argyle Ballroom Chair: Dr Sudhakar Rao
1100-1230 Concurrent Session 8 - Rural Trauma Stirling Room Chair: Ms Maxine Burrell
1100-1230 Concurrent Session 9 - Paediatric Trauma Karri Room Chairs: Ms Helen Jowett and Dr Warwick Teague
1100-1120 Current evidence based management of major burns Prof. Fiona Wood
1100-1120 Rural trauma outcomes Prof. Daniel Fatovich
1100-1115 Lessons learned from 500 paediatric major trauma cases in NSW Prof. Andrew Holland and Ms Belinda Kennedy
1120-1135 Update on abdominal compartment syndrome Dr Kate Martin
1120-1140 Training for trauma care in the rural environment Dr Sally McCarthy
1115-1130 The cut and thrust of paediatric chest trauma Dr Warwick Teague
1135-1150 REBOA in acute trauma management Dr Dieter Weber
1140-1200 Is a retrieval team always required for inter-hospital transfer of patients with major trauma? Dr Tony Smith
1130-1145 Paediatric eFAST: Black and white or 50 shades of grey? Dr James Flynn
1150-1205 Brachial plexus injury: Management update Dr Alex O’Beirne
1200-1220 Trauma nursing in a remote environment Ms Caroline Cordy-Hedge
1145-1200 The paediatric red blanket Dr Rebecca Cooksey
1200- 1215 Paediatric cervical spine controversies Dr Nicole Williams
1205-1220 Spinal injury: Current concepts in management Mr David Dillon
1220-1230 Questions 1220-1230 Questions 1215-1230 Paediatric trauma is like a box of chocolates… Ms Sarah Adams
1230-1330 Lunch Swan Room
1330-1500 Plenary Session 4 - National Road Safety Strategy Argyle Ballroom Chair: Dr Tony Joseph
1330-1345 How to engage government in the road safety discussion Mr Craig Newland, Australian Automobile Association
1345-1400 The clinical perspective of road safety Dr John Crozier, RACS Trauma Committee
1400-1415 WA road safety strategy update Mr Iain Cameron, WA Road Safety Council
1415-1435 Moving towards a safe road system in New Zealand Ms Lisa Rossiter, NZ Transport Agency
1435-1450 How civil engineering can influence the debate on road safety Mr Warren Sharpe, Institute of Public Works Engineering Australasia
1450-1500 Question time
1500-1530 Afternoon Tea Swan Room
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Program continued
1530-1730 Concurrent Session 10 - Innovations in Trauma Argyle Ballroom Chair: Ms Alicia Jackson
1530-1700 Concurrent Session 11 - Allied Health and Health Science Session Stirling Room Chair: Prof. John Buchanan
1530-1730 Concurrent Session 12 - Free Papers - Outcomes Karri Room Chair: Ms Trish McDougall and Ms Andrea Herring
1530-1550 What is the current place for hypothermia in patients with traumatic brain injury? Prof. Stephen Honeybul
1530-1550 Is it safe to discharge patients still in PTA – A retrospective review Mr Carlo Divita
1530-1545 Reviewing prehospital trauma deaths Dr Ben Beck
1550-1610 The optimal management of major haemorrhage in the trauma patient Dr Kerry Gunn
1550-1610 Concussion – Clinical application of emerging evidence Mr Alec Ring
1545-1600 Trauma call ratio: A new Royal Australasian College of Surgeons process indicator in trauma care Dr Grant Christey
1610-1630 The thrombo-elastogram: A standard of care in trauma centres? A/Prof. Dan Ellis
1610-1630 Rehabilitation for chest trauma Ms Fiona Coll
1600-1615 Increasing number of hospitalised bicycle injuries during 2005–2016 Mr Ingar Næss
1630-1650 Fibrinogen early in severe trauma study (FEISTY) Dr Don Campbell
1630-1650 Balance and vestibular disorders after injury Ms Deb Crawley
1615-1630 The impact of frailty in critically ill trauma patients: A prospective observational study Ms Claire Tipping
1630-1645 Prevalence and management of mild traumatic brain injury at the Royal Melbourne Hospital: A retrospective audit Ms Eloise Thompson
1650-1710 Code crimson efficacy and outcomes Dr Mark Friedericksen
1650-1710 Integrating orthotic technology and trauma recovery Mr Steve Carpenter
1645-1700 Outcomes and costs of severe lower extremity injury Prof. Belinda Gabbe
1700-1715 Trauma occupational therapy at the Royal Darwin Hospital: A unique model of care Ms Erica Bleakley
1710-1730 Question time 1710-1730 Question time 1715-1730 Comparison of functional capacity index scoring with abbreviated injury scale 2008 scoring in predicting 12-month severe trauma outcomes Mr Cameron Palmer
1930-2400 Conference Dinner Argyle Ballroom
*Program is subject to change
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*Program is subject to change
Sunday 7 October 2018
0900-1000
Plenary Session 5 - Best Papers of 2017/18 Argyle Ballroom Chair: Prof. Michael Parr
Dr Ian Civil and Dr Tony Joseph
1000-1030 Morning Tea Pre-Event Area
1030-1200 Plenary Session 6 - Future of Trauma Care Panel Session and Close of Meeting Argyle Ballroom Chair: Dr Tony Joseph
Prof. Fiona Lecky, A/Prof. David Zonies, Prof. Michael Parr and Dr Ian Civil
I M P R O V I N G C A R E O F T H E I N J U R E D
The NTRI is the leading trauma research institute
in Australia. We collaborate with organisations
nationally and internationally to integrate Research,
Education, Medical Technologies and Trauma Systems
Development to improve clinical care and outcomes
for injured people.
This year we welcome NTRI Gold Coast Hospital,
the newest NTRI branch that we hope will lead to
other branches across the country, and
internationally.
The home of the Australian Trauma Registry (ATR),
we encourage the trauma community at Trauma 2018
to share their vision of the ATR and the Australian
Trauma Quality Improvement Program (AusTQIP).
www.ntri.org.au
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The posters will be displayed in the Pre-Event Foyer and Swan Room of the Parmelia Hilton Perth on Friday 5 October and Saturday 6 October 2018.
1 Cyclists and helmets – effective or false sense of security Dr Vindya Abeysinghe
2 Not a nanny state – the ethical justification for injury prevention public health policies Dr Keith Amarakone
3 Blood alcohol level is NOT affected (diluted) by large volume resuscitation or
transfusion
Dr Megge Beacroft
4 Trends in prehospital trauma deaths in Victoria Dr Ben Beck
5 Characteristics and outcomes of adult trauma patients attended by St John
Ambulance paramedics in metropolitan Perth
Ms Elizabeth Brown
6 The development of a major trauma recovery coordinator position: A pilot project Ms Sara Calthorpe
7 Measurement of mobility and physical function in hospitalised trauma patients: A
systematic review of instruments and their measurement properties
Ms Sara Calthorpe
8 Early in-reach rehabilitation for trauma patients at a major trauma centre - initial
experience
Dr Don Campbell
9 Experience of blunt cardiac injury in a major trauma centre: A retrospective analysis Dr David Cheng
10 Retrospective review of traumatic thoracic spine injuries: “Are we missing
something?”
Dr Erasmia Christou
11 Sudden ending of life – palliative and pastoral care Rev Ken Devereux
12 Assessment of the impacts of the Optimised Recovery After Trauma (ORAT) program
reported by multidisciplinary team members at a major trauma centre
Ms Jennifer Dorrian
13 A prospective review of approaches to cervical spine immobilisation practice in a
tertiary trauma centre
Dr Nargus Ebrahimi
14 Radiological findings of abdominal injuries of the soft tissues within seat belt
syndrome on computed tomography (CT)
Dr Claire Elliot
15 Video-tube thoracostomy in trauma resuscitation Dr Peter Finnegan
16 Evaluating Resuscitative Balloon Occlusion of the Aorta (REBOA) FOR exsanguinating
trauma related haemorrhage in an adult Australian trauma center
Prof. Mark Fitzgerald
17 AIIMS Trauma Reception and Resuscitation© (TRR©) system: A preliminary trial of
the introduction of trauma resuscitation decision support to India
Prof. Mark Fitzgerald
18 Implementing a trauma registry in Saudi Arabia: A Saudi Trauma Registry (STAR) is
born
Ms Jane Ford
19 Acute traumatic coagulopathy management in the pre-hospital setting - it’s about
bleeding time...
Dr Andrew Hooper
20 Computed Tomography (CT) based diagnosis as an alternative to post mortem in
trauma patients
Dr Darren Karadimos
Poster Presentations
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21 Rib fracture management in an increasing elderly population Mr James Laurent
22 Introduction of pre-hospital notification of injured patients presenting to trauma
centres in India
Dr Joseph Mathew
23 The Australian Trauma Registry (ATR) – a national view of serious trauma Ms Emily McKie
24 Renal trauma: A decade in review Dr Munyaradzi Nyandoro
25 A ten year experience with traumatic renal pseudoaneurysm Dr Munyaradzi Nyandoro
26 Evaluating the severity of paediatric Australian Rules Football injury Mr Cameron Palmer
27 Critical incidents and trauma deaths - It’s about perspectives Dr George Perrett
28 Cardiac contusions: A comparison of nuclear medicine imaging and transthoracic
echocardiography in blunt trauma
Dr Adam Philipoff
29 Management intervention significantly improves trauma outcomes at one of the
busiest emergency department in Perth
Ms Glynis Porter
30 Finger thoracostomy in children: An overview of the paediatric experience in trauma
in Victoria
Dr Nuala Quinn
31 Live patient simulation: An exciting tool in trauma education Dr Tom Ryan
32 External benchmarking of trauma services in New South Wales: Risk-adjusted
mortality after moderate to severe injury from 2012 to 2016
Dr Pooria Sarrami
33 Motorcycle crash trauma admissions in the Midland Region of New Zealand: What the
Police don’t see
Dr Alastair Smith
34 Validation of two physical activity and sedentary behaviour questionnaires in
orthopaedic trauma patients
Mr William Veitch
35 Evaluation of the major trauma recovery coordinator role: Early findings Mr William Veitch
36 Work-related traumatic injury in Australian truck drivers Dr Ting Xia
37 A retrospective analysis of the utility of cervical spine MRI in patients with normal CT
and plain radiographs
Dr Adeline Yap
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nationaltraumacentre.nt.gov.au
Australia’s National Critical Care and Trauma Response Centre (NCCTRC) remains a vital element of the Australian Government’s capacity to respond to regional disasters.The NCCTRC continues to lead the way with international disaster response and are experienced in deploying AUSMATs to disaster zones, working effectively alongside local allied health staff to provide primary health care to affected communities.
Rapid. Medical. ResponseExpecting the unexpected
National Critical Care and Trauma Response Centre @NatTraumaCentre @NatTraumaCentre
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THURSDAY 4 OCTOBER 2018
Nursing Quality Improvement and Data Management Forum
$100 registration fee
9am to 5pm
Parmelia Hilton Perth
Trauma Registries are the underpinning essential tool
for all Trauma Services. These are used to improve
patient care via performance improvement, complication
minimisation, case management and research.
Understanding the data collected in a registry is a special
skill, understanding how your data is collected and the
definition used can change the implications of what is
collected.
This workshop is aimed at all Trauma Service Registry
staff and Trauma Service Program Managers to enhance
your knowledge in data quality, what to collect and how,
getting the data out of the registry in a meaningful way,
analysis tools available and reviewing quality indicators.
Workshop sponsored by:
Allied Health and Health Science Workshop
$100 registration fee
9am to 12pm
Parmelia Hilton Perth
Lets’ make your job easier to prepare your trauma
patient for discharge or transfer to another service.
This workshop will cover the essentials to communicate
to patients and other providers, rehabilitation that is
possible within clinical restrictions, creating recovery
programs from minimal resources, factors for healing,
overcoming misconceptions, multi-trauma case studies,
management of spinal injuries and useful measures.
Trauma Ultrasound Workshop
$250 registration fee
9am to 12pm
Parmelia Hilton
Keen to learn how to perform eFAST scanning? This short
course will teach you how, and is also suitable for those
looking to get numbers for their logbook. On the day, most
of your time will be spent scanning normal and ‘abnormal’
volunteers. You will be taught by faculty drawn from
local Emergency Physicians who have subspecialised in
Ultrasound. Before the course there will be approximately
2 hours of online videos to watch and a short pre-quiz
to complete. The course will be most useful to you and
your patients if you do pursue credentialing through the
ASUM’s (Australasian Society for Ultrasound in Medicine)
eFAST CCPU, or through the ACEM. You can do this course
with absolutely no background knowledge of Ultrasound,
and you are sure to enjoy yourself.
Workshop sponsored by:
Emergency Airway Management Workshop
$125 registration fee
2pm to 3:45pm
Parmelia Hilton Perth
This multi-disciplinary, team-focused interactive
workshop will provide an overview of the knowledge and
skills essential to provide safe airway management. It will
focus on identifying and safely managing those at high
risk of airway difficulty. During the 90 minute workshop,
participants will rotate through presentations, small
group discussions, hands-on skills stations, and mini-
scenario/simulations relevant to a broad range of clinician
backgrounds, facilitated by a team of airway experts. Pre-
reading will provide essential background on the concepts
required to make safe airway management a “team
sport” in which effective communication and the use of
cognitive aids can prevent or avert a crisis situation.
Workshops
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Trauma Research Workshop
Complimentary registration
2pm to 5pm
Parmelia Hilton Perth
The workshop will allow researchers to present their
work for feedback regarding clinical application, engaging
others in multi-institutional projects, and constructive
feedback on how to improve the study design. It will
also allow researchers to present work that presents
significant logistical challenges so that others may learn
from their experience.
SATURDAY 6 OCTOBER 2018
Visco-Elastic Monitoring (TEG/ROTEM) in Trauma Bleeding Workshop and Breakfast
$50 registration fee
7am to 8:25am
Parmelia Hilton Perth
A workshop where the current monitors are
demonstrated and aspects of their introduction into
hospitals and department discussed. There will be an
opportunity for hands on processing of a sample, and
demonstration of the software. A small group discussion
will cover systems and guidelines that incorporate TEG/
ROTEM in clinical decision making in the patient with
massive haemorrhage.
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Social Program
CPD Information
Welcome Reception
Venue: Swan Room, Parmelia Hilton Perth
Date: Friday 5 October 2018
Time: 1800-2000
Dress: Smart Casual
Cost: Included in full delegate registration.
Day delegate or guest tickets available for $85
Directly following the first day of conference sessions
we invite all delegates and trade exhibitors to come
together for drinks and canapés in the Swan Room. This
is a great way to network, catch up and celebrate the
official opening of the conference.
Conference Dinner
Venue: Argyle Ballroom, Parmelia Hilton Perth
Date: Saturday 6 October 2018
Time: 1930-2400
Dress: Cocktail
Cost: Full delegate registration: $60 per person
Day delegate, trade, students & guests: $140 pp
Relax and unwind with your conference colleagues over a
3 course sit down meal and beverages. A live band will of
course be there for those that wish to put their dancing
shoes on or simply listen to some great music.
Conference dinner sponsored by:
All conference delegates will receive a certificate of
attendance after the conference which can be used to
claim points for their attendance. The Trauma Conference
has received accreditation for the following CPD points.
Australasian College for Emergency Medicine (ACEM)
The conference has been accredited for 18.5 ACEM CPD
hours. Participants can and should update the stated
number of hours to reflect their individual activity.
College of Intensive Care Medicine of Australia and New Zealand (CICM)
Lectures – Category 2A: Passive Group Learning,
1 point per hour
Workshops – Category 2B: Active or Interactive Small
Group Learning, 2 points per hour
Royal Australasian College of Surgeons (RACS)
This educational activity has been approved in the
RACS CPD Program. Fellows who participate can claim
one point per hour in Maintenance of Knowledge and
Participation in this activity will be populated into your
RACS CPD Online.
Australian College of Rural and Remote Medicine (ACRRM)
The conference has been accredited for 19 Core points.
ACRRM ID: 14123
Class name: Trauma 2018 Conference - Perth - 04-
07/10/2018
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ACCOMMODATION AND LUGGAGE
Parmelia Hilton Perth
14 Mill Street, Perth WA 6000
Tel: +61 8 9215 2000
Web: www3.hilton.com/en/hotels/western-australia/
parmelia-hilton-perth-PERHITW/index.html
Adina Apartment Hotel Perth
30 Mounts Bay Road, Perth WA 6000
Tel: +61 8 9217 8000
Web: www.adinahotels.com/hotel/perth/
Rendezvous Hotel Perth Central
24 Mount Street, Perth WA 6000
Tel: +61 8 9481 0866
Web: www.tfehotels.com/en/hotels/rendezvous-hotels/
perth-central/
All delegates are reminded that aside from prepaid room
charges all incidentals and charges at the hotel are to be
settled upon check out.
Please also note that the Conference Registration Desk
has no storage facilities – please leave your luggage with
the hotel concierge if attending the conference after you
have checked out of your hotel room.
CREDIT CARDS
Credit cards accepted at the Conference Registration
Desk are Visa, Mastercard and AMEX. Merchant fees
apply. Most Perth hotels, restaurants and shops will
accept all major credit cards.
CAR PARKING
Parmelia Hilton Perth
The hotel provides a full valet parking service, bays are
subject to availability and there is a strict height limit of
1.9m. Guests can have their car valet parked securely
undercover. Concierge staff will bring their car to the
front of the hotel as many times as required for no extra
charge. Full valet service for $55 a day.
Westralia Square – Secure Parking
You are eligible to receive a 25% discount when pre-
booking at Westralia Square.
Visit www.secureparking.com.au/westraliasquare and
select SECURE A SPOT.
Join as a registered member. Book your date & time of
stay. You will receive a pin code to use upon entry and
exit of the car park.
DELEGATE LIST
A delegate list was emailed out in advance of the
Conference. Delegates who indicated on their
registration form that they did not want their name and
organisation to appear on the list have been excluded.
INSURANCE
As you will be incurring considerable expense when
attending this event, it is strongly recommended that you
take out an insurance policy of your choice when booking
your travel arrangements.
INTERNET
Basic complimentary Wi-Fi will be available in the
Exhibition area. Connection instructions:
1. Connect to @Honors
2. When the login page appears, enter the access code:
ztrauma
LIABILITY DISCLAIMER
The Organising Committee, including the Trauma 2018
Secretariat, will not accept liability for damages of any
nature sustained by participants or their accompanying
persons or loss of or damage to their personal property
as a result of the meeting or related events.
LOST PROPERTY
Please report all lost or found property immediately to
the staff at the Conference Registration Desk.
General Information
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NAME BADGESAll delegates will be given a name badge at registration. For security reasons, we ask that you wear your name badge at all times. This name badge is also the official entrance to all Conference sessions, exhibition, catering areas and social functions.
REGISTRATION DESKRegistration material for the event (name badge, function tickets & detailed program) may be collected from the Trauma 2018 Registration Desk during the below times.
Thursday 4 October 2018 0800 – 1700 for pre conference workshop attendees
Friday 5 October 2018 0700 – 2000 hours
Saturday 6 October 2018 0700 – 1730 hours
Sunday 7 October 2018 0830 – 1200 hours
The Registration Desk will be located in the Pre-Event area on Level 1 and staff will be happy to help with any queries.
SMOKING POLICY
The Parmelia Hilton Perth is a non-smoking venue.
Smoking is strictly prohibited in all enclosed public
spaces. This policy also applies to restaurant, shopping
centres and bars in Perth.
SPEAKER PREPARATION
All speakers are asked to check their audio-visual
material before presenting. We ask that you check-in
with the audio-visual technicians at least 2 hours prior to
your presentation, or first thing in the morning of your talk.
The speakers preparation room is located in the Fremantle
Room. Presentations of each session will be loaded onto a
secure server for easy access during your talk.
More than a simple X-ray room The Multitom RAX is an X-ray system that delivers fast and accurate X-ray images with outstanding image quality but can be much more. RAX confirm fluoroscopy provides real time X-ray guided imaging enabling greater precision in the administration of treatment for acutely unwell patients. Real 3D imaging delivers CT like high resolution imaging of bone anatomy to see the unseen fractures, assess joint involvement more easily, or assist in the planning of complex surgeries and all without the need to wait for a CT scan or the patient leaving the ED precinct.
A paradigm shift in precision medicineIntroducing Multitom RAX
Courtesy of University Hospital Basel/Switzerland
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Floor Plan
Level 1, Parmelia Hilton Perth
REGISTRATION DESK
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Exhibition Floor Plan
Pre-Event Foyer and Swan Room, Parmelia Hilton Perth
Exhibitor List
Defence Force Recruiting 1
National Critical Care & Trauma Response Centre 2
Haemonetics 3
Ambulance Victoria 4
National Trauma Research Institute (NTRI) 5
KCI Medical 6
FUJIFILM SonoSite 7
Tristel 8
LifeHealthcare 9
Haemoview Diagnostics 10
MediGroup EBI 11
iSimulate 12
Siemens Healthineers 13
Experien Insurance Services Coffee Stand
5
7
8
4
3
2
1
REGISTRATION
9
1011 12
6
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Sponsors and Exhibitors
The trade exhibition will be located in the Pre-Event
Foyer and Swan Room and is open 0930-2000 on Friday
5 October and 0730-1530 on Saturday 6 October. Tea
breaks and lunch will be served in this area to enable you
to visit all exhibitors whose support of Trauma 2018 is
invaluable and much appreciated.
Ambulance Victoria – Stand 4
Contact: Danielle McDonald
Address: 75 Brady St, South Melbourne VIC 3205
Telephone number: +61 3 9090 2346
+61 409 540 093
Email address: Trauma.victoria@ambulance.vic.gov.au
Website: www.trauma.reach.vic.gov.au/
Trauma Victoria is a trauma focused, sustainable
educational system funded by the Department of Health
and Human Services and is managed by Adult Retrieval
Victoria. The Trauma Victoria Website http://trauma.
reach.vic.gov.au hosts the Victorian Major Trauma
Guidelines, a LMS, moderated tutorials, and downloadable
resources. All resources are now available via an APP to
all clinicians, doctors, nurses and paramedics.
Defence Force Recruiting – Stand 1
Contact: Ian Appleton
Address: Level 7/66 St Georges Terrace, Perth WA 6000
Telephone number: +61 8 9488 7180
Email address: iappleton@dfr.com.au
Website: www.defencejobs.gov.au
The Australian Defence Force is one of the world’s leading military organisations. We fulfill key defensive roles as well as providing a range of peacetime services. The ADF provides a formidable military capability built upon expertly-trained personnel and technically-advanced vessels, vehicles, aircraft and weapons. Working in close cooperation, the Navy, Army and Air Force are tasked with
the defence of our nation, its borders and coastline our
people and their values, and our way of life.
FUJIFILM SonoSite – Stand 7
BRONZE SPONSOR
Contact: Michael O’Hara
Address: 114 Old Pittwater Road, Brookvale NSW 2100
Telephone number: +61 447 226 465
Email address: michael.ohara@fujifilm.com
Website: www.sonosite.com/au
FUJIFILM SonoSite, Inc. is the innovator and world leader in bedside and point-of-care ultrasound, and an industry leader in ultra high-frequency micro-ultrasound technology. SonoSite’s portable, compact systems are expanding the use of ultrasound across the clinical spectrum by cost-effectively bringing high-performance ultrasound to the point of patient
care. Please visit www.sonosite.com/au
Hol loway Product ions | Trauma Vic | F ina l
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Haemonetics – Stand 3
Contact: Kim Atherton
Address: 123 Epping Road, Macquarie Park NSW 2113
Telephone number: +61 448 162 123
Email address: kim.atherton@haemonetics.com
Website: www.haemonetics.com
Haemonetics (NYSE: HAE) is a global healthcare
company dedicated to providing a suite of innovative
haematology products and solutions for customers, to
help them improve patient care and reduce the cost of
healthcare. To learn more about Haemonetics,
visit www.haemonetics.com.
Haemoview Diagnostics – Stand 10
Contact: Violeta Jardin
Address: 433 Logan Road Stones Corner,
Brisbane QLD 4120
Telephone number: +61 7 3394 8373
Email address: info@haemoview.com.au
Website: www.haemoview.com.au
Haemoview Diagnostics is an Australian company where
haemostasis& bleeding management are our passion.
We Provide solutions for rapid, whole blood diagnosis of
coagulopathies utilising our range of ROTEM, Multiplate
and VerifyNow products. Our goal is to assist you to
Improve patient outcomes through differential diagnosis
and goal directed targeted therapy. Please feel free to
contact us any time.
iSimulate – Stand 12
Contact: Brent Carlisle
Address: Unit 17 Molonglo Mall, Fyshwick ACT 2609
Telephone number: +61 2 6129 8200
Email address: brent.carlisle@isimulate.com
Website: www.isimulate.com
iSimulate provides medical simulation technology that
makes it easier, simpler and more cost-effective to train
health professionals. Established in 2011, iSimulate
products are used in hospitals, universities and private
training organisations. The company’s tablet-based
technology has been rapidly embraced by the medical
industry around Australia and the world at large.
KCI Medical – Stand 6
Contact: Sylvia Jimenez, Marketing & Events Specialist
Address: Level 7, 15 Orion Road,
Lane Cove West NSW 2066
Telephone number: +61 418 438 498
Email address: sylvia.jimenez@acelity.com
Website: www.acelity.com
AcelityRestoring People’s Lives. Acelity is a globally
diversified wound care and regenerative medicine
company uniting the strengths of KCI (Negative
Pressure Wound Therapy) and Systagenix (Advanced
Wound Dressings). Acelity is committed to advancing
the science of healing and restoring people’s lives. We
deliver value through innovative and comprehensive
product portfolio, combined with specialised knowledge
that leads the industry in quality, safety and customer
experience.
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LifeHealthcare – Stand 9
Contact: Bronwyn Pedersen
Address: Level 8 15 Talavera Road, North Ryde NSW 2113
Telephone number: +61 449 902 635
Email address: bronwyn.pedersen@lifehealthcare.com.au
Website: www.lifehealthcare.com.au
At LifeHealthcare we bring Australian and New Zealand
healthcare professionals innovative medical devices
by partnering with world class companies who share
our vision for innovation and making a real difference to
people’s lives. Together with our partners all over the world,
our people work closely with healthcare professionals to
ensure the highest standards of patient care.
MediGroup EBI – Stand 11
Contact: Chris Ignatiadis 0400 111 703
Address: Level 1, 530 Lt Collins St, Melbourne VIC 3000
Telephone number: +61 400 111 703
1300 362 534
Email address: c.ignatiadis@medigroup.com.au
Website: www.medigroup.com.au
Award-winning 3D Rib Clip simplifies rib trauma fixation.
Efficient, portable Sinapi Chest Drain for reduced length
of stay and increased mobility. Kelocote UV, the only
scar treatment with UV protection to meet updated scar
guidelines. Visit MediGroup EBI at booth 11 - committed
to innovation in healthcare.
Siemens Healthineers – Stand 13
BRONZE SPONSOR
Contact: Samantha Gallagher
Address: 885 Mountain Hwy, Bayswater VIC 3153
Telephone number: +61 428 249 545
Email address: sam.gallagher@siemens-healthineers.com
Website: www.healthcare.siemens.com.au/
Siemens Healthineers enables healthcare providers
worldwide to increase value and human impact by
empowering them on their journey towards expanding
precision medicine, transforming care delivery, improving
patient experience and digitalising healthcare. As a
leader in medical technology, Siemens Healthineers is
constantly innovating; driving new paradigms in its core
areas of diagnostic and therapeutic imaging, laboratory
diagnostics and molecular medicine.
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National Critical Care & Trauma Response Centre – Stand 2
GOLD SPONSOR
Contact: Michelle Foster
Address: Level 8 Royal Darwin Hospital Darwin NT 0810
Telephone number: +61 8 8922 6929
Email address: Michelle.foster@nt.gov.au
Website: www.nationaltraumacentre.nt.gov.au
Centre is strategically positioned in the Top End of the
Northern Territory to rapidly respond to sudden health
emergencies both onshore across Australia, and offshore
throughout Asia Pacific. The NCCTRC provides clinical and
academic leadership in trauma and critical care through the
Australian Medical Assistance Team (AUSMAT) training.
National Trauma Research Institute (NTRI) – Stand 5
BRONZE SPONSOR
Contact: Jessica Bradford
Address: Level 4, 89 Commercial Road,
Melbourne VIC 3004
Telephone number: +61 3 9076 8806
Email address: je.bradford@alfred.org.au
Website: www.ntri.org.au
The National Trauma Research Institute was established in
2003 by partnership institutions Alfred Health and Monash
University. Recently a branch at the Gold Coast Hospital
was established. We collaborate with organisations
nationally and internationally to integrate Research,
Education, Medical Technologies and Trauma Systems
Development to improve clinical care and outcomes.
Tristel – Stand 8
BRONZE SPONSOR
Contact: Scott Pabst, National Sales Manager
Address: 40/328 Reserve Road, Cheltenham, VIC 3192
Telephone number: 1300 680 898
Email address: mail-au@tristel.com
Website: www.tristel.com
Tristel is the global leader in chlorine dioxide disinfectant
solutions for infection prevention and contamination
control. Its lead technology has been a ground-breaking
innovation in the world of Infection Control. Tristel has
been providing hospitals around the world with the
safest, fastest and smartest disinfectant solutions for
over two decades.
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Invited Speaker Abstracts
OPENING PLENARY SESSION
TRAUMATIC BRAIN INJURY AND HOW TO OPTIMISE OUTCOMES
Fiona Lecky1
1. Clinical Professor of Emergency Medicine, University of Sheffield, Sheffield, United Kingdom
Recent data confirms that Traumatic Brain Injury causes two thirds of all major injury deaths in patients reaching hospital alive and is the commonest cause of death and disability in European Citizens under 40. Current management strategies aim to reduce secondary brain injury. Whilst there is good basic science evidence on how to achieve this - supported by big data - the execution in modern trauma care systems is often not straightforward.
The lecture will reflect upon these TBI management challenges in the acute phase, particularly the areas of TBI triage at the injury scene, older patients and the optimal pathway post CT
brain whilst highlighting recent research findings and relevant
ongoing studies.
THE PLACE OF ECMO IN ACUTE TRAUMA RESUSCITATION
David Zonies1
1. Associate Professor of Surgery, Oregon Health & Science University, Oregon, United States of America
Extracorporeal life support has evolved considerably
over the past two decades. Once considered a salvage or
experimental therapy in adults, extracorporeal membrane
oxygenation (ECMO) is evolving into a mainstream
treatment for adult critical care. This is especially true in
trauma and high-risk surgical patients who have traditionally
been excluded from consideration. Several technological
advances have made this possible. This includes
anticoagulant-bonded circuits, device miniaturization,
servo-regulated centrifugal systems, and more efficient
oxygenators. Adult ECMO may now be rapidly deployed for
severe acute respiratory distress syndrome (ARDS) and
cardiogenic shock. Trauma and surgical patients with severe ARDS should be considered for ECMO early in their clinical course to provide optimal lung rest.
THE CURRENT ROLE OF DECOMPRESSIVE CRANIECTOMY: BASED ON THE CURRENT EVIDENCE AND ETHICAL PRACTICE
Stephen Honeybul1
1. Consultant Neurosurgeon, Department of Neurosurgery, Sir Charles Gairdner Hospital and Royal Perth Hospital, Western Australia
There would appear to be little doubt that decompressive craniectomy can reduce mortality. However for many years there has been concern that any reduction in mortality may come at an increase in the number of survivors with severe
neurological disability. Over the past decade there have
been several randomised controlled trials comparing surgical
decompression with standard medical therapy in the context
of ischaemic stroke and severe traumatic brain injury. These
studies have provided unequivocal evidence that surgical
intervention reduces mortality in the context of “malignant”
middle infarction and following severe traumatic brain
injury. However, it has only been possible to demonstrate
an improvement in outcome by categorizing a mRS of 4 and
upper severe disability on the extended Glasgow outcome
scale as favourable outcome. This is contentious and an
alternative interpretation is that surgical decompression
reduces mortality but exposes a patient to a greater risk of
survival with severe disability.
These results do not necessarily mean that use of
the procedure should be abandoned however; further
evaluation by way of further randomised controlled trials
would seem unlikely. It may be that observational cohort
studies and outcome prediction models may provide data
to determine those patients that may benefit from surgical decompression.
PREDICTING OUTCOMES FOLLOWING MILD TRAUMATIC BRAIN INJURY
Aleksandra Gozt1,2, Melissa Licari , Alison Halstrom4, Hannah Milbourn4, Anna Black1,2, Glenn Arendts5,11, Stephen Macdonald5,9,11, Swithin Song10, Ellen Macdonald9,11, Michael Bynevelt6,8, Carmela Pestell7, Daniel Fatovich5,9,11, Melinda Fitzgerald1,2,4
1. Curtin Health Innovation Research Institute, Curtin University, Perth, Western Australia, Australia
2. Perron Institute for Neurological and Translational Science, Ralph and Patricia Sarich Neuroscience Research Institute Building, Verdun St, Nedlands, Western Australia
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3. Telethon Kids Institute, West Perth, Western Australia
4. School of Biological Sciences, The University of Western Australia; Western Australia
5. Emergency Medicine, The University of Western Australia; Western Australia
6. School of Surgery, The University of Western Australia, Western Australia
7. School of Psychological Science, The University of Western Australia, Western Australia
8. Neurological Intervention & Imaging Service of Western Australia
9. Emergency Department, Royal Perth Hospital, Western Australia
10. Radiology Department, Royal Perth Hospital, Western Australia
11. Centre for Clinical Research in Emergency Medicine, Harry Perkins Institute of Medical Research, Perth, Western Australia
Post-Concussion Syndrome (PCS) is a complex condition
in which the symptoms of concussion continue to persist
beyond the timeframe that they typically resolve. If
individuals at risk of PCS could be identified soon after
injury, they could then be directed to interventions
appropriate to their symptoms, thereby limiting long-term
negative effects. However, there is currently a lack of
predictive measures that can be used to direct clinical
care. Here, we assessed blood-based biomarkers, MRI
outcomes and neuropsychological outcomes in a cohort
of concussion patients at the time of presentation to
Royal Perth Hospital Emergency Department (T0), and
related these to outcomes at 28 days (n=36), and/
or to outcomes in age matched healthy controls. PCS
was defined based on outcomes in the Rivermead Post
Concussion Questionnaire (RMPCQ), or a score equal
to, or exceeding, 1.5 standard deviations below the
sample mean in any two of the other neuropsychological
assessments at 28 days after injury. Initial assessments
indicate that the Repeatable Battery for the Assessment
of Neuropsychological Status total score was significantly
lower at T0 in patients that developed PCS, than in
patients that recovered normally (t (34) = 2.8215;
p = 0.008). The trail making task B time (TMT B), the
Depression Anxiety Stress Scales (DASS-21) total score
and the RMPCQ total score at T0 were each significantly
correlated with the RMPCQ score at 28 days (TMT B
& RMPCQ r = 0.414, p = 0.012; DASS-21 & RMPCQ r =
0.406; p = 0.014). Diffusion Tensor Imaging analyses
using tract based spatial statistics in a subset of patients
indicated that fractional anisotropy measures in the
left inferior frontal occipital fasciculus (IFOF) at T0 were
significantly lower in mTBI patients than healthy controls
(t (20.587) = -2.174; p = 0.042). This area of the brain
has been implicated in visual-spatial processing abilities.
Consistent with this, the decreased FA values within the
left IFOF were correlated with impaired performance on
the RBANS Visual-Constructional subscale (r = 0.552, p =
0.033). The ultimate goal is to establish a predictive model
of PCS based on a suite of outcome measures that can be
used to identify patients at risk of poor outcome following
concussion.
The work is part of a broader initiative to improve lives
following traumatic brain injury (TBI), called Repair-TBI. We
are bringing together paramedics, emergency physicians,
intensivists, neurotrauma specialists, neurologists,
neuroscience researchers, neuropsychologists and
advocacy representatives from all states and territories
in Australia, working together to address key unmet needs
in TBI research. We aim to (1) identify the predictors of
outcome and (2) develop interventions that can improve
the lives of children and adults with TBI.
CONCURRENT SESSION 1: TRAUMA CONUNDRUMS
ELDERLY TRAUMA AND OPTIMAL OUTCOMES
Fiona Lecky1
1. Clinical Professor of Emergency Medicine, University of
Sheffield, Sheffield, United Kingdom
In 1990 the median age of major trauma patients in the UK
was 36 years, increasing slowly to 40 years in 2006, but
then increasing rapidly to 54 years in 2013. The lecture
explores the drivers for the recent dramatic change in terms
of underlying population changes, and trauma imaging
practices. This increasingly important Silver Trauma group
is compared to younger patients in terms of presenting
characteristics, trauma management and outcomes with
key messages for trauma network configuration.
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PALLIATIVE CARE IN TRAUMA: A NEW SUB-SPECIALTY?
David Zonies1
1. Associate Professor of Surgery, Oregon Health & Science University, Oregon, United States of America
Trauma results in acute and chronic physical, spiritual and emotional injuriey for patients and their families. This can be as devastating as their new physical limitations. Palliative care, with its focus on multidisciplinary symptom management and coordinated care, is evolving as an integral component of trauma care. Palliative care may be integrated as the fourth pillar of acute surgical care (trauma surgery, emergency general surgery, critical care, palliative care), where the surgeon and team have an obligation to focus all efforts toward a patient’s stated goals. Screening patients in need of specialty palliative care, such as frail persons at the extremes of age, spinal cord injuries, traumatic brain injuries, or those with complex comorbidities or social circumstances allows for better allocation of palliative care resources.
WHAT IS THE RIGHT SIZE FOR A CHEST TUBE? DOES SIZE MATTER?
Savitha Bhagvan1
1. Trauma Consultant, Auckland City Hospital, Auckland, New Zealand
One of the controversies of chest drain placement in trauma involves the size of the tube. While we prefer to place larger tubes to drain haemothorax, there has not been much evidence regarding the ideal drain size. Here, we present a review of literature.
PLENARY SESSION 2: TRAUMA OUTCOMES
THE TARN EVALUATION OF THE UK NHS TRAUMA SYSTEM AFTER REORGANISATION
Fiona Lecky1
1. Clinical Professor of Emergency Medicine, University of
Sheffield, Sheffield, United Kingdom
Trauma care in England was re-organised in 2012 with newly designated Major Trauma Centres (MTCs), trauma units
and ambulance trauma triage. The lecture will present the rationale for this change and data constituting a longitudinal series of annual cross-sectional studies of care process and outcomes from April 2008 to March 2017 from the trauma audit and research network (TARN). The primary analysis was carried out on the 110,863 patients admitted to 35 hospitals that were ‘consistent submitters’ throughout the study period.
Major Trauma networks were associated with significant increased patient numbers treated in Major Trauma Centres and all hospitals, more consultant led care, more rapid imaging, an increase in older trauma, and new massive transfusion policies with use of tranexamic acid. There were 10,247 (9.2%) deaths in the 110,863 patients with an ISS of 9 or more. There were no changes in unadjusted mortality. The analysis of trends in risk adjusted survival for study hospitals will be presented.
THE BURDEN OF INJURY IN THE DEVELOPING WORLD: ARE THERE TANGIBLE SOLUTIONS
David Zonies1
1. Associate Professor of Surgery, Oregon Health & Science
University, Oregon, United States of America
Trauma continues to be a leading cause of global morbidity and mortality. More than 5 million deaths and over 900 million people are injured as a result of injury. The global burden of this disease falls primarily to low and middle-income countries. There are several proven and cost-effective strategies that may strengthen existing systems and improve patient outcomes. Improved access to quality trauma resuscitation and timely surgical care will improve outcomes in this vulnerable population. A review of examples of effective strategies and systematic
improvements will be presented.
THE NEW ZEALAND PREHOSPITAL FATAL INJURY OUTCOME STUDY
Bridget Kool1, Rebbecca Lilley, Gabrielle Davie, Brandon de Graaf, Ian Civil, Charlie Branas, Bridget Dicker, Shanthi Ameratunga
1. Associate Dean (Academic), Faculty of Medical and Health Sciences, University of Auckland, New Zealand.
Despite the significant impact of serious injury on the
health system and wider society, no national studies have
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investigated the preventability of injury deaths in New Zealand
(NZ). This study aims to address that gap. We undertook a
retrospective review of all post-mortems from injury deaths
in NZ that occurred prehospital between January 2009
and December 2012. Deaths without physical injuries (e.g.
drownings, poisonings), where there was no complete body,
and deaths associated with mass casualty events (> 20
deaths), were excluded. The documented injuries were scored
using the Abbreviated Injury Scale 2005 and from this an
Injury Severity Score (ISS) was derived. Cases were classified
as survivable (ISS <25), potentially survivable (ISS 25-49)
and non-survivable (ISS >49) based on the ISS groupings of
Sampalis et al. Of the 3050 prehospital injury deaths identified
during the study period where a PM was present, 1254 (41%)
did not meet the scoring eligibility criteria. Of the 1796 cases
that we were able to be ISS scored, 10.7% (n= 193) had
injuries classified as survivable, 27.9% (n= 501) potentially
survivable and 61.4% (n= 1102) non-survivable. The ratio of
non-survivable to survivable/potentially survivable injuries was
highest for burns (n=4.7:1). The majority of injured people in
NZ who die before reaching hospital do so from non-survivable
injuries. However, 38.7% (n=694) have either potentially
survivable or survivable injuries. These results suggest that
there should be further attempts at improving prehospital care,
reducing potential inequities in access to care, and sustaining
primary prevention efforts.
CONCURRENT SESSION 4: TRAUMA EDUCATION
IS THERE A ROLE FOR SIMULATION IN TRAUMA TRAINING
Anthony Lock1
1. Director, Non-Technical Skills & Human Factors Training, Royal Perth Hospital, Perth, Western Australia
Effective simulation training in any safety critical
environment is a significant enabler to improving the team
and individual performance – maximising the learnings from
success and failures. However, from a personal point of
view, how efficient is our learning from a simulated event?
Do we have both an individual and team growth mindset to
extract all lessons and take on board those debrief points
that are confronting and hard to hear? Research has proven that maximum personal growth, in whatever we do, comes
from that productive discomfort we may experience when receiving feedback. Is there value in seeking constructive criticism from colleagues and trainers no matter our level of experience?
Military and airline aviation place an equal weighting on assessment scores when measuring performance in both technical and non-technical skills. We see other
safety-critical industries, such as deep sea diver training,
mining, rail, shipping and business embracing the full use
of simulation training, not only to increase safety and
maintain core business but to move on to effectiveness,
efficiency, precision and finally perfection.
As an ex-military combat and airline pilot, it took me a long time to realise the value of simulation training. I needed to be better and move beyond just being safe. Changing to a growth mindset was the key to achieving maximum personal and professional development. Can we do the
same in medical simulation? I believe we can!
CONCURRENT SESSION 5: MILITARY TRAUMA
TRAUMA AND CRITICAL CARE OUTCOMES: WHAT CAN WE LEARN FROM THE MILITARY?
David Zonies1
1. Associate Professor of Surgery, Oregon Health & Science
University, Oregon, United States of America
It is said that the only victor of war is medicine. Indeed,
every modern conflict has accelerated advances in
surgical care. The United States and its allies have been
at war for close to two decades and recent conflicts in
Iraq and Afghanistan are no different. Since 2001, trauma
care has advanced with the development of new dressings, drugs, and devices. There have been improvements in surgical technique and in some cases, old lessons relearned. The military advanced burn and trauma resuscitation, adapted techniques to modern situations, and advanced the critical care of injured servicemembers. A new and cohesive military trauma system has developed in parallel to modern civilian trauma systems. Crosspollination between
the military and civilian trauma systems have resulted in
bidirectional strengthened systems. Highlights of the
most important advances will be described.
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BUILDING AND EVALUATING THE MILITARY TRAUMA SYSTEM
Lt. Col. Anthony Chambers1
1. Commanding Officer 3rd Health Support Battalion Australian Army and Head of Dept of General Surgery, St Vincent’s Hospital, Sydney, NSW
The military trauma system is an integrated network capable of providing health support to deployed forces. The Australian Army’s deployable military trauma system is known as the Land Based Trauma System. It comprises casualty evacuation capability using air and land means, as well as medical treatment facilities capable of performing
damage control resuscitation and surgery for both
combat casualties and non-combat injuries. To confirm
the readiness and capability of Army’s deployable health
units these undergo regular certification and assessment.
The 3rd Health Support Battalion is the Australian Army’s
provider of specialist health support, and is tasked with the
certification of Army’s deployable health capabilities. This
presentation will describe the capability and composition of
the Army’s Land Based Trauma System, and the means by which it is certified, evaluated and benchmarked.
CONCURRENT SESSION 6: PRE HOSPITAL SESSION
DESIGNING FIRE & EMERGENCY AVIATION SERVICES IN WESTERN AUSTRALIA
Derek Parks1
1. Director Aviation Services, Department of Fire & Emergency Services, Western Australia
Aviation is an integral part of contemporary emergency services, but are even more critical in Western Australia’s
extraordinarily large and demographically unique jurisdiction.
Extreme distances, remoteness from emergency services,
incident inaccessibility and other barriers such as fire,
flood or traffic congestion, often mean that DFES relies on
aviation capabilities and services to provide a timely and
effective response. For this reason, DFES employs a range
of aviation capabilities throughout Western Australia to
achieve its strategic control priorities.
DFES Aviation Services are a substantial operation. The
Department’s Aviation Services are organised along funding
lines and functional outputs. They fall into either the State
Emergency Rescue Helicopter Service or Air Operations
Branch. WA’s jurisdiction is unique. The timeliness and
effectiveness of most emergency responses depend to some extent on DFES’ and sister agencies’ aviation services.
DFES Air Operations encompass various categories of operations. Air transport is an integral enabler for emergency response to regional and remote areas. Aerial intelligence surveillance and reconnaissance inform emergency response and disaster management. Aerial application operations encompass a range of all-hazards air attack such as aerial firefighting, aerial marine pollution response, and aerial incendiary operations.
DFES also runs the State’s only dedicated 24-hour medical Emergency Rescue Helicopter Service. The helicopters operate as part of the State’s road Ambulance network but perform other search and rescue operations. These operations support DFES’ highest strategic priority - “to protect and preserve life”.
These services are a major operational and financial undertaking for the State in an evolving machinery of government. To assure continued relevance, and to ensure maximum return on investment, DFES has applied a new
capability framework to redesign its aviation services and
an effects-based approach to manage them operationally.
The outcomes include new operational and governance
interfaces; a transforming aircraft fleet, evolved staff skills
and enabling base facilities.
THE EVOLUTION OF PRE-HOSPITAL TRAUMA CARE
David Ford1
1. Course Coordinator - Post Graduate Paramedicine, Edith Cowan University, Perth, Western Australia
How has pre-hospital trauma care evolved for patients with
major trauma? The potential contribution of the pre-hospital
phase of trauma care cannot be over-estimated with up to
85% of trauma deaths occurring outside of the hospital.
Over the past 20 years, pre-hospital trauma care has
changed radically with the introduction of trauma systems,
trauma bypass and rotary wing aeromedical retrieval
platforms. Many clinical interventions such as blood
products and ultrasound, once the domain of in-hospital
care, are becoming commonplace in the pre-hospital
setting. Also, a number of procedures and equipment
that were universally considered standard practice in
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pre-hospital trauma care have been removed from clinical
practice guidelines. How have these changes to systems
and clinical interventions impacted on the patient journey and
outcomes and do they mitigate the adverse effects of time
and distance and decrease patient mortality for patients
with major trauma.
AEROMEDICAL TRAUMA RETRIEVAL IN THE LARGEST STATE
Andrew Hooper1
1. Acting Director of Medical Services, Royal Flying Doctor Service Western Operations, Western Australia
Western Australia consists of a third of the landmass
of Australia, over 2.5 Million square kilometres in area.
Specialist trauma services are confined to the Perth metropolitan area in the South West, with limited capacity to manage patients with major trauma across the rest of the state. We are faced with the challenge of rapidly
responding to trauma in extremely remote areas, providing
high level trauma management in austere conditions,
and transporting patients thousands of kilometres to
specialist trauma care. This presentation explores the
challenges, innovations and solutions to these challenges.
WAR AND PEACE – LESSONS FROM THE BATTLESPACE
Dr. Tony Robins1
1. MBBS, MBA, GCert LCC, FRACGP, FRACMA, Executive Director Medical Services, Western Australia Country Health Service
With reference to Australian General, Sir John Monash’s 1918
military doctrine for highly coordinated, three dimensional battlespace warfare, human combatants are identified as key strategic assets. A key military objective being to integrate trauma systems into battlespace operations to preserve and protect human life to the greatest extent possible.
Military trauma systems have evolved into highly coordinated and effective, point-of-injury through post rehabilitation discharge care pathways based on 600 years experience, since the first recorded ambulance support of army campaigns in the 15th Century.
Key features of these systems include: single system
command, control and communication structures;
comprised of agile mobile and fixed elements; capable of
high reliability response; utilising land, air and maritime
assets (including human crews) under common command;
with added ability to identify and deploy secondary care
capability; embedded within a learning and prevention
framework that supports the patient care path, end to end.
A civilian emergency care model, based on the WHO
Emergency Care Framework, is considered and compared to a military model. Noting significant differences in operating environments and growing challenges facing civilian care organisations, possible learnings for the “peacespace” are
proposed, based on military trauma system experience.
PLENARY SESSION 3: MASS CASUALTIES
NERVE AGENTS: AN UPDATE
Michael Reade1
1. Defence Professor of Military Medicine and Surgery, Australian Defence Force and University of Queensland, Brisbane, Queensland, Australia
First- and second- generation nerve agents were developed
immediately prior to, during, and after the Second World War. Most are liquid at room temperature, with volatility determining their degree of persistence. G-agents (e.g. GA (tabun) and GB (sarin)) are non-persistent, while V-agents (e.g. VX, VR) are persistent. All inhibit acetylcholinesterase, causing acetylcholine excess in nerve terminals with resulting skeletal muscle weakness, miosis, hypersalivation, lacrimation, urination, vomiting, seizures, respiratory depression and death. Countermeasures include pre-treatment with carbamate anticholinesterases (e.g. pyridostigmine) to reversibly bind cholinesterase, preventing nerve agent binding. These must be taken regularly but are limited by gastrointestinal adverse effects. Post-exposure treatment incudes atropine (at doses exceeding those in usual clinical practice e.g. 2mg IV q5min, doubling each dose, up to 200mg IV, to effect) and acetylcholinesterase reactivators such as pralidoxime, obidoxime and dimethanesulfonate DMS – which must be given before the ‘ageing time’ of the nerve
agent, which varies from 2 minutes to 48 hours. Novichok
(‘newcomer’) nerve agents, developed in the Soviet Union
in the 1960s-1990s, are technically not covered by the
International Chemical Weapons Convention. Many are
binary weapons, only becoming toxic when two precursors
are mixed. Conventional acetylcholinesterase reactivators
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are ineffective, and unlike earlier nerve agents, limited experience with Novichok survivors suggests persistent nerve damage. Catalytic bioscavengers and novel oximes have been evaluated in preclinical trials with some success. Recent UK experience exposed the vulnerability of a city to even tiny quantities of Novichok, and the reliance upon conventional healthcare resources in dealing with patients affected by these agents.
CHALLENGES IN DESIGNING DISASTER RESPONSE CAPACITY FOR MAJOR MEDICAL EMERGENCIES
Paul Barnes1, 2
1. The Australian Strategic Policy Institute, Canberra, Australian Capital Territory
2. Torrens Resilience Institute at Flinders University, Adelaide, South Australia
Public health systems and the hospitals embedded within
them may be presumed to operate at close to optimal
levels across a range of service categories. While a health
system is a part of a suite of essential services how should
critical elements of it - specifically hospitals - prepare for
continuity of operations when the services they depend on
are disrupted during disaster events?
This session examines selected challenges to thinking
about contingency and continuity planning for hospitals that
need to sustain functionality during significant disasters
when critical support or enabling systems may be non-
functional or at risk of being lost due to the impacts of
cascading disruptions.
CONCURRENT SESSION 7: CLINICAL UPDATES
CURRENT EVIDENCE BASED MANAGEMENT OF MAJOR BURNS
Fiona Wood1
1. Director, Burns Service of WA and Director, Burn Injury Research
Unit University of Western Australia, Perth, Western Australia
Every intervention from the time of injury with influence
survival and the quality of survival. From the initial first aid, prehospital interventions in preparation for transfer, retrieval, and onto tertiary specialist care there are therapeutic
opportunities to improve the outcome. Education and training with open communication is key to accurate assessment along the clinical journey, well enabled by telehealth solutions. Major burns are best treated in a specialist environment by a specialist multidisciplinary team. In WA the challenges of geography will be discussed to highlight solutions which
facilitate care such that the patient is optimised by the time
of arrival into the definitive care facility.
CONCURRENT SESSION 8: RURAL TRAUMA
RURAL TRAUMA OUTCOMES
Daniel Fatovich1,2
1. Director of Research, Royal Perth Hospital, Perth, Western Australia
2. Centre for Clinical Research in Emergency Medicine, Harry Perkins Institute of Medical Research University of Western Australia, Western Australia
The ‘golden hour’ of trauma care is irrelevant in rural areas. This
project studied the effect of distance, time and remoteness
on major trauma patients transferred by the Royal Flying Doctor
Service (RFDS) from rural and remote Western Australia. The
RFDS and Trauma Registry databases were linked for the
period of July 1, 1997, to June 30, 2006. Major trauma was
defined as Injury Severity Score (ISS) >15. Remoteness
was quantified using the Accessibility/Remoteness Index
of Australia (ARIA) classes: inner regional, outer regional,
remote, and very remote. The primary outcome was death.
Among 1328 major trauma transfers to Perth, mean age
was 34.2 years and 979 (73.7%) were male. Over half were
motor vehicle crashes. Mean transfer time was 11.6 hours
(95% confidence interval [CI], 11.2–12.1). The median ISS
was 25 (interquartile range [IQR], 18 –29), and there were
no differences within the ARIA classes for cause and injury
patterns. After adjusting for ISS, age, and time, the risk of
death increases as remoteness increases: outer regional
odds ratio (OR), 2.25 (95% CI, 0.58 – 8.79); remote, 4.03
(95% CI 1.04 –15.62); and very remote, 4.69 (95% CI,
1.23–17.84). Risk increases by 87% for each 1,000 km (OR,
1.87; 95% CI, 1.007–3.48; p 0.05) flown. There is an excess of
a fourfold increase in the risk of major trauma death in patients
transferred to Perth from remote and very remote Western
Australia. Remoteness, as measured by the ARIA, is more
important than distance, in the risk of death.
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CONCURRENT SESSION 9: PAEDIATRIC TRAUMA
LESSON LEARNED FROM REVIEW OF OVER 500 PAEDIATRIC TRAUMA CASES IN NSW
Andrew J. A. Holland1,2, Belinda Kennedy2
1. The Children’s Hospital at Westmead, New South Wales, Australia
2. The University of Sydney, Sydney, New South Wales, Australia
Injury is the leading cause of death and disability for
children in Australia. Timely and appropriate treatment
reduces the risk of adverse health outcomes. There
is known variability in care delivery to injured children,
and reported preventable in-hospital deaths. Children
in NSW receiving definitive care at a Paediatric trauma
centre (PTC) are 3-6 times more likely to survive,
compared to those treated at an Adult trauma center.
The reasons for the variability in outcomes, along with
the number of avoidable and unavoidable deaths, and the
appropriateness of care delivery in NSW is unknown.
To address this gap in knowledge, a NHMRC partnership
project ‘Evidence to change policy and improve health
outcomes for severely injured children’ sought to
establish the current care pathways from the time of
injury to discharge, examine the appropriateness and
processes of care, determine the health service delivery
costs for injured children and establish health related
quality of life outcomes.
Injured children < 16 years requiring intensive care, or with
an injury severity score > 9, or who die following injury
in NSW between July 2015 and September 2016 were
included. They were identified via NSW PTCs, NSW Trauma
Registry, NSW medical retrieval registry and the National
Coronial Information Service. A full medical record review
was conducted for all children receiving definitive care
at a PTC in NSW to establish the existing care pathways,
and care received, from time of injury to discharge. This
presentation will present an overview the findings related to the treatment journey for injured children.
PAEDIATRIC EFAST: BLACK AND WHITE OR 50 SHADES OF GREY?
James Flynn1
1. Emergency Physician Perth Children’s Hospital and Royal Perth Hospital, Perth Western Australia, Australia
The extended focused assessment with sonography for
trauma (eFAST) scan has limited sensitivity in the diagnosis
of intra-abdominal injuries, especially in children. It is an
important adjunct, however, during the primary survey
of the child with traumatic shock. It also has a role as a
trauma triage tool during multi-casualty incidents. There is
a significant learning curve and maintenance requirement in order to maintain eFAST skills. Given that traumatic shock & disaster scenarios are rare events, it is important to incorporate the eFAST into clinical assessment protocols for all paediatric trauma patients in order to maintain a pool
of competent clinicians who can reliably perform an eFAST
when the situation demands it.
PAEDIATRIC CERVICAL SPINE CONTROVERSIES
Nicole Williams1
1. Director (Research and Education) Paediatric Major Trauma Service, Women’s and Children’s Hospital, Adelaide, South Australia2. Associate Professor, Centre for Orthopaedic and Trauma Research, University of Adelaide, South Australia
Cervical spine injuries are relatively uncommon in the
paediatric population but when they occur in association
with major trauma, mortality rates up to 30% may be
seen. Even relatively minor injuries are a source of
significant patient and care-giver as well as clinician
anxiety. Clinician anxiety can arise from inconsistency
in guidelines, lack of knowledge regarding anatomical
variants and difficulties with communication and
cooperation in young children. This presentation explores
the evidence surrounding current controversies in
paediatric cervical spine management including whether
and how to immobilise in the acute care setting and
whether and how to investigate radiologically. Data
from the Adelaide Women’s and Children’s Hospital will be presented as well as a summary of the local and international literature.
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PLENARY SESSION 4: NATIONAL ROAD SAFETY STRATEGY
HOW TO ENGAGE GOVERNMENT IN THE ROAD SAFETY DISCUSSION
Craig Newland1
1. Technical Director, Australian Automobile Association, Canberra, Australian Capital Territory
Road safety is of paramount importance to the Australian
Automobile Association (AAA) and its constituent state-
and territory-based motoring clubs.
To support its advocacy on road safety, the AAA undertakes
research and analysis to provide an evidence basis to identify
road safety problems and propose solutions. This includes:
• regular monitoring of trends in road fatalities
• tracking progress against the targets in the National Road Safety Strategy 2011-2020
• identifying deficiencies in road safety data
• conducting economic research to quantify the cost of road trauma in Australia
• advocating structural improvements to national road safety management
• supporting the Australasian New Car Assessment program (ANCAP)
• undertaking objective assessment of the safety of road infrastructure through the Australian Road Assessment Program (AusRAP).
The AAA is an active participant in road safety, providing submissions to Government on road safety and related budgetary issues, as well as disseminating fact sheets and reports through the media and working with strategic partners to advocate road safety solutions.
WA ROAD SAFETY STRATEGY UPDATE
Iain Cameron1
1. Acting Commissioner of Road Safety, Chair – Western Australia Road Safety Council, Perth, Western Australia, Australia
Western Australia remains one of the worst performing
Australian states for road trauma. Despite a record low 161 deaths in 2017 the rate of 6.2 deaths/100,000 population remains above the Australian average of 5.0 and well behind Victoria at 4.0.
Encouragingly, the rate of improvement in WA since 2006
is close to the best with a 36% reduction in the rate of
deaths per 100,000 population comparable to 37-40% in
the leading states and above New Zealand, the USA and
France (24-30%) but behind Spain (61%) the UK (49%)
and Sweden (46%).
Since 2008, road safety effort in WA has been guided by
the Towards Zero strategy for 2008-2020, at the time of
release and still today up there with international leading
practice having adopted the safe system approach and an
ambitious aim to reduce serious road trauma by 40% by
2020.
Within WA, progress varies with a slower improvement
rate in regionally and greater improvements for the
occupants of vehicles compared to pedestrians, cyclists
and motorcyclists. Crashes involving young people have
declined at a greater rate than other ages.
Crashes due to risk taking are declining at a faster rate
than crashes due to errors showing education, enforcement
and legislation is having impact but with about 70% of all
serious crashes involving mistakes/inattention, there is more
to be done to reduce “system risk”.
Automated speed and drink driving enforcement is working,
engineering improvements to intersections, shoulder sealing
and audible edge-lining on country roads are working and
vehicle safety improvements are working.
Going forward there is a need to “double down” and
implement more of what works based on evidence while
developing and engaging the community and opinion leaders
in the level of ambition and directions for a new road safety
strategy post 2020.
How much safety do we want? What are we prepared to do
and support? How do we build community and opinion leader
support for a paradigm shift in our approach to a safe system
that caters for human error and continues to reduce risk
taking?
Governments provide leadership and resources but support
in a shared responsibility from individuals to corporations is
critical for our continued progress and a level of road safety
for our community equal to the best.
What will you do?
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CONCURRENT SESSION 10: INNOVATIONS IN TRAUMA
WHAT IS THE CURRENT PLACE FOR HYPOTHERMIA IN PATIENTS WITH TRAUMATIC BRAIN INJURY?
Stephen Honeybul1
1. Consultant Neurosurgeon, Department of Neurosurgery, Sir Charles Gairdner Hospital and Royal Perth Hospital, Western Australia
Over the past two decades there has been considerable
interest in the use of hypothermia in the management of
severe traumatic brain injury. However despite promising
experimental evidence, results from clinical studies have
failed to demonstrate benefit. Indeed recent studies have
shown a tendency to worse outcomes in those patients
randomized to therapeutic hypothermia. In this narrative review
the pathophysiological rationale behind hypothermia and
the clinical evidence for efficacy are examined. There would
still appear to be a role for hypothermia in the management
of intractable intracranial hypertension. However optimizing
therapeutic time frames and better management of strategies
for complications will be required if experimental evidence for
neuroprotection is to be translated into clinical benefit.
THE OPTIMAL MANAGEMENT OF MAJOR HAEMORRHAGE IN THE TRAUMA PATIENT
Kerry Gunn1
1. Deputy Clinical Director (Perioperative), Department of Anaesthesia and Perioperative Medicine, Auckland City Hospital, New Zealand2. Senior Lecturer, Dept of Anaesthesiology, University of Auckland, New Zealand
Trauma has few benefits. But for the study of the response
of the human’s physiology to shock it provide a unique model
to explain changes that have troubled clinicians for decades
in understanding why patients continue to bleed when
normally they do not.
If a patient has severe trauma defined by evidence of
shock and ongoing, uncontrolled bleeding they have a 20%
mortality, which increases to 40-50% if in addition they
have a coagulopathy. They are 8 times more like to die in the
next 24 hrs with a coagulopathy than not, and results from the PROPPR and PROMMTT 1 studies suggest that rapid resuscitation with fibrinogen rich blood products may reduce
bleeding, improve short term survival, but not such that in hospital mortality is reduced.
The development of a coagulopathy has been recognised for many years since Cannon 2recognised the delirious effect of resuscitation of patients with clear fluids in battlefield trauma. The dilutional coagulopathy does not explain the profound blockade in coagulation in shock. Evidence currently points to poorly perfused endothelium, stimulated by a hyper adrenergic sympathetic system exuding thrombomodulin and activated Protein C into the microcirculation.3 This effects PAI-1 to promote fibrinolysis, inhibit FV and FVII to stimulate thrombin, and thus limit clot forming in the microcirculation. While this may preserve the organ if perfusion is re-established, the systemic effects of this are to induce non-surgical bleeding that increases mortality in the trauma patient.
Thus, and in tandem with this the previously intact glycocalyx is damaged. 4When large crystalloid resuscitation fluids are used the protein and heparan matrix within the extra-endothelial layer loses its integrity. Fluid loss through the basement membranes increases, and he effectiveness of the circulation is impaired.5
Indicators of increased mortality using coagulation parameters show that they are the result of profound shock. Elevated Protein C levels, Syndactin–C levels (indicating glycocalyx destruction) and elevated adrenaline levels all are associated with abnormalities in coagulation parameters (INR, aPPT), and TEG abnormalities.6 Similar changes in platelet aggregation occur.
The resulting clinical problems are a patient in shock with bleeding from non-surgical wounds, that continues to bleed after the trauma pathology is fixed. This leads to abdominal compartment syndrome, Multisystem organ failure and death.
Empiric responses to this have been a rapid recognition of patients at risk, rapid transport to a definitive site of bleeding control (operating room or interventional radiology), damage control surgery, which involved rapid surgery limited to stopping bleeding, then stopping, Damage control resuscitation which involves limiting crystalloid, empiric use of Tranexamic acid at a dose of 15mg/kg bolus plus an infusion over 1 hrs, blood given in either a 1:1:1 fixed ratio, or targeted to a TEG or ROTEM, and sometimes permissive hypotension. Patients with persistent acidosis and hypothermia are managed in the
ICU until stabilised before definitive trauma surgery
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Together these bundles of care have reduced mortality
form massive haemorrhage in trauma substantially.7
The question is where these lessons can be applied in
other surgical areas. While the principles are logically
applied to any surgery that includes shock and
uncontrolled bleeding, in normal high blood loss surgery
evidence is lacking to aggressive resuscitation along
these lines. A warm, not shocked patient with limited
tissue trauma behaves differently and focused therapy
is more logical. In Cardiothoracic surgery, the effect of
drugs that are anticoagulant and antiplatelet need to be
specifically reversed rather an empirically treated.
The concept of Goal directed therapy where
abnormalities are corrected only in bleeding patients
has the advantage of focussing therapy on laboratory
abnormalities. The most validated of these is using a TEG
or ROTEM. It further allows treatment with less exposure
to allogenic blood products, and less system waste. 8,9But it usually needs specialist skills and a dedicated
person controlling the resuscitation.
The question in the future is if we need to add a person to the team. There has usually been an airway specialist, should we add a bleeding specialist?
THE THROMBO-ELASTOGRAM: A STANDARD OF CARE IN TRAUMA CENTRES?
Dan Ellis1
1. Acting Director of Trauma, Royal Adelaide Hospital, Adelaide, Australia.
The introduction of thromboelastography into some
centres has completely altered the approach to massive
transfusion and blood/blood product use in major trauma.
For those without access to thromboelastography it
might all seem complicated and expensive. In reality the
introduction of this into a major trauma service is not
that hard or that expensive. This presentation offers
some reassurance on making your thromboelastography
dreams a reality.
FIBRINOGEN EARLY IN SEVERE TRAUMA STUDY (FEISTY)
James Winearls1, Christa Bell2, Elizabeth Wake3, Glen Ryan4, James Walsham5, Catherine Hurn6, Melita Trout7, John Roy8, Prof. Roy Kimble9, Dhane George10, Don Campbell11
1. Consultant Intensivist, Gold Coast University Hospital, Southport, Queensland2. Children’s Critical Care, Gold Coast University Hospital, Southport, Queensland3. Trauma Research Coordinator, Gold Coast University Hospital, Southport, Queensland4. Consultant Emergency Medicine, Princess Alexandra Hospital, Woolloongabba, Queensland5. Consultant Intensivist, Princess Alexandra Hospital, Woolloongabba, Queensland6. Consultant Emergency Medicine, Royal Brisbane and Women’s Hospital, Herston, Queensland7. Consultant Intensivist, The Townsville Hospital, Douglas, Queensland8. Paediatric Haematologist, Lady Cilento Children’s Hospital, South Brisbane, Queensland9. Director of Trauma, Lady Cilento Children’s Hospital, South Brisbane, Queensland10. Consultant Emergency Medicine and Paediatric Intensive Care, Gold Coast University Hospital, Southport, Queensland11. Deputy Director of Trauma Service, Gold Coast University Hospital, Southport, Queensland
Introduction:
Trauma causes 40% of child deaths in high income
countries, with haemorrhage being a leading cause of death.
Hypofibrinogenaemia plays a significant role in traumatic
haemorrhage and is associated with worse outcomes,
particularly in children. Early fibrinogen replacement may
reduce haemorrhage and improve outcomes. This study
will assess the effects of a targeted dose of Fibrinogen
Concentrate (FC) vs standard care (Cryoprecipitate) in
traumatic haemorrhage. FEISTY Junior aims to replicate
FEISTY, appropriately modified for the paediatric population.
Hypothesis:
Fibrinogen replacement in traumatic haemorrhage can be
achieved quicker using FC compared to Cryoprecipitate.
Primary Study Aims:
• Investigate the feasibility of early fibrinogen
replacement in traumatic haemorrhage utilising either FC
or cryoprecipitate.
• Compare time to administration of fibrinogen
replacement between FC and Cryoprecipitate
• Investigate effects of fibrinogen replacement on
fibrinogen levels during haemorrhage
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Design:
Multi-centre, randomised controlled, un-blinded, feasibility pilot study
Primary Outcome Measures:
Time to administration of Fibrinogen Replacement from presentation at the Trauma Centre.
Secondary Outcome Measures:
• Transfusion requirements
• Duration of bleeding episode
• ICU and Hospital LOS
• Duration of Mechanical Ventilation
• Adverse Events
Inclusion:
• Patient between 3 months and 17 years affected by Trauma
• Judged to have significant haemorrhage OR Predicted to require significant transfusion by treating clinician judgement
• Activation of local MHP or transfusion of emergency red cells.
Intervention:
• 44 patients randomised into FC (Intervention) or Cryoprecipitate (Comparator) arms
• Requirement for fibrinogen replacement triggered by pre-specified ROTEM values
Summary:
• This study will add to the evidence base in paediatrics as currently there are no published studies comparing FC and Cryoprecipitate in the paediatric population.
CODE CRIMSON EFFICACY AND OUTCOME
Mark William Friedericksen1
1. Consultant, Emergency Department and Trauma Service, Auckland City Hospital, Auckland, New Zealand.
Trauma Code Crimson (TCC) was introduced at Auckland
City Hospital on 26 August 2015, the aim of TCC is to
attempt to identify those trauma patients that my require
urgent surgical or interventional radiological intervention
and to get the Senior Clinical decision makers to the
patient’s bedside to facilitate appropriate and rapid
clinical decisions.
TCC requires significant interdepartmental collaboration including the pre-hospital team.
There have been 51 Trauma Code Crimson activations between 26 August 2015 and 31 December 2017. 35 (70%) patients has ISS of >16. 31 (61%) patients went from level 2 to the operating theatre, 16 (31%) went directly from the resuscitation room and 15 went from CT to theatre. There were 14 (27%) hospital deaths and 7
(50%) of the deaths were in the Emergency Department.
CONCURRENT SESSION 11: ALLIED HEALTH AND HEALTH SCIENCE SESSION
IS IT SAFE TO DISCHARGE PATIENTS STILL IN PTA – A RETROSPECTIVE REVIEW
Carlo Divita1
1. Senior Occupational Therapist, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
Background: Historically, patients with traumatic brain
injury would not be discharged in to the community
before emergence from post-traumatic amnesia, on the
assumption that they may experience more adverse
outcomes than those discharged after emergence from
post-traumatic amnesia.
Methods and Procedures: A retrospective review
of previously collected data and medical records of
patients from a subacute rehabilitation ward was
completed. Occurrence of adverse events including
hospital readmissions, disengagement from follow-up
services, non-compliance with discharge precautions,
support system breakdown or undue carer strain at the
post-discharge clinic review were recorded. The Glasgow
Outcome Scale – Extended and Supervision Rating
Scale, were completed retrospectively. 27 patients
discharged into the community, prior to emergence from
Post-traumatic Amnesia were compared to 20 patients
discharged within seven days of emergence from Post-
traumatic Amnesia.
Main Outcomes and Results: Patients discharged from a
subacute ward, prior to emergence from Post-traumatic
Amnesia did not experience an increase in adverse
outcomes and showed a higher level of engagement in
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follow-up services (p=0.015). There was no difference
between groups in the improvements from discharge
to clinic review on the Glasgow Outcome Scale-Extended (p=0.113) and Supervision Rating Scale (p=0.165).
Conclusions: There is potential for patients to be discharged prior to emergence from Post-traumatic Amnesia, if related symptoms have stabilised and are predictable, and they have the necessary supports and follow-up in the community, without an increase in adverse outcomes.
CONCUSSION – CLINICAL APPLICATION OF EMERGING EVIDENCE
Alexander Ring1
1. Clin. Senior Lecturer, School of Medicine – UWA, Adj Research Fellows, IIID, Murdoch University & School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
Background: Sport Related Concussion (SRC) is defined
as representing the immediate and transient symptoms of
traumatic brain injury (TBI). SRC is evolving and therefore
individual management and return-to-play/school decisions remain in the realm of clinical judgement. The emerging evidence of management had changed since the first consensus in SRC -Vienna 2001 advocating an initial period of rest until acute symptoms resolve. Computerized Neuropsychological testing demonstrated that patients were “cognitively ready” to RTP by day 6 (Lovell et al, 2004 ). Leddy and colleagues demonstrated that a better prediction of physical RTP was to also utilize a graded way to test symptoms by using the Balke protocol on a treadmill (Buffalo Concussion Treadmill Test -BCTT) .
Our clinic deals with sub-acute and the more complex Post-Concussive Syndrome (PCS). New evidence shows a significant difference between those who rest, stretch or use graded-exercise protocols in length of recovery time. Our changed approach to treatment is based on collaborations and observed clinical research from 5 North American clinics and updated as evidence emerges. Our comprehensive clinical examination that allows us to create a baseline that gauges where the patient is at currently. This then allows a target orientated therapy that is precise, and goal focused. Functional outcomes are tangible for the patient as they see progress, and this keeps them focused on their Rehabilitation.
References: Lovell, M., Mihalik, J., Stump, J., Collins, M.,
Field, M., & Maroon, J. (2005). Posttraumatic migraine characteristics in athletes following sports-related concussion. Journal of Neurosurgery, 102(5), 850–855.
Leddy, J., Baker, J. G., Haider, M. N., Hinds, A., & Willer, B.
(2017). A Physiological Approach to Prolonged Recovery
From Sport-Related Concussion. Journal Of Athletic
Training (Allen Press), 52(3), 299-308.
REHABILITATION FOR CHEST TRAUMA
Fiona Coll1
1. Senior Physiotherapist, State Major Trauma Unit Royal Perth Hospital, Perth Western Australia
Objective: Working aged adults performed the modified
Chester Step Test (mCST) to: (i) assess the reliability and validity of the test; (ii) report cardiorespiratory and symptom responses; and, (iii) calculate the minimal detectable change (MDC).
Design: Observational study with data collection completed during a single session.
Setting: Hospital Physiotherapy department.
Subjects: Healthy adults aged between 25 and 65 years.
Intervention: Participants performed the mCST twice. This required participants to step on and off a 20 cm step at standardised cadences that increased every 2 minutes. The criteria for test completion was either the; (i) attainment of a heart rate equal to 80% predicted maximum or, (ii) onset of intolerable symptoms.
Main measure: Time to test completion during the mCST (s). Cardiorespiratory and symptom responses were also collected during the mCSTs.
Results: Eighty-three participants (40 males, mean [SD] age 44 [12] yr) completed data collection. There was no effect of repetition with test duration on the two tests, being median (25th to 75th percentile) 522s (400 to 631s) and 501s (403 to 631s), respectively (p=0.24). The test elicited moderate symptoms of breathlessness and leg fatigue. In the multivariable model, age, sex, weight and height were retained as significant predictors of test duration (R2=0.50). The MDC was 119 s.
Conclusion: The mCST is simple, portable and is reliable in
healthy people. The MDC indicates the clinical applicability
of the test.
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CONCURRENT SESSION 3: FREE PAPERS- ACUTE CARE
FIBRINOGEN CONCENTRATE VS. CRYOPRECIPITATE IN SEVERE TRAUMATIC HAEMORRHAGE IN CHILDREN: A PILOT RANDOMISED CONTROLLED TRIAL
Elizabeth Wake1, Christa Bell1, James Winearls1, 2, Glenn Ryan3, James Walsham4, Catherine Hurn5, Melita Trout6, John Roy7, Roy Kimble7, Shane George1, 8
1. Gold Coast University Hospital, Southport, Queensland, Australia
2. School of Medicine, University of Queensland, Brisbane, Queensland, Australia
3. Emergency Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia
4. Intensive Care Unit, Princess Alexandra Hospital, Bundall, Queensland, Australia
5. Emergency Department, Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia
6. Intensive Care Unit, Townsville Hospital, Townsville, Queensland, Australia
7. Lady Cilento Children’s Hospital, Brisbane, Queensland, Australia
8. School of Medical Sciences, Griffith University, Gold Coast, Queensland, Australia
Introduction: Trauma causes 40% of child deaths in
high income countries, with haemorrhage being a leading cause of death. Hypofibrinogenaemia plays a significant role in traumatic haemorrhage and is associated with worse outcomes, particularly in children. Early fibrinogen replacement may reduce haemorrhage and improve outcomes. This study will assess effects of a targeted dose of Fibrinogen Concentrate (FC) vs standard care (Cryoprecipitate) in traumatic haemorrhage. FEISTY Junior will replicate FEISTY, modified for the paediatric population.
Hypothesis: Fibrinogen replacement in traumatic haemorrhage can be achieved quicker using FC compared to Cryoprecipitate.
Study Aims:
1. Investigate the feasibility of early fibrinogen replacement in traumatic haemorrhage utilising either FC or cryoprecipitate.
2. Compare time to administration of fibrinogen replacement between FC and Cryoprecipitate
3. Investigate effects of fibrinogen replacement on fibrinogen levels during haemorrhage
Design: Multi-centre, randomised controlled, un-blinded, feasibility pilot study
Primary Outcomes: 1. Time to administration of Fibrinogen Replacement from presentation at the Trauma Centre.
Secondary Outcomes:
1. Transfusion requirements
2. Duration of bleeding episode
3. ICU and Hospital LOS
4. Duration of Mechanical Ventilation
5. Adverse Events
Inclusion:
1. Patient between 3 months and 17 years affected by Trauma
2. Judged to have significant haemorrhage OR Predicted to require significant transfusion by treating clinician judgement
3. Activation of local MHP or transfusion of emergency red cells.
Intervention: 44 patients randomised into FC (Intervention) or Cryoprecipitate (Comparator) arms
Requirement for fibrinogen replacement triggered by pre-specified ROTEM values
Summary: This study will add to the evidence base in paediatrics as currently there are no published studies
comparing FC and Cryoprecipitate in the paediatric
population.
PELVIC BINDER PLACEMENT - TIGHTENING IT UP
Chris CB Bong1, 2, David DL Lockwood1, 2, Meg MM Mckerrow3
1. Department of Surgery, Acute Surgical Unit, Brisbane, Queensland, Australia
2. Princess Alexandra Hospital, Brisbane, Queensland, Australia
3. Princess Alexandra Hospital, Department of Medical Imaging, Brisbane, Australia
Pelvic binders are important in stabilising pelvic fractures
and preventing haemorrhages in the trauma patient. They
Oral Abstracts
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are most effective when placed at the level of the greater
trochanters.1 The SAM sling is the standard pelvic binder
used by the Queensland Ambulance Service (QAS),2 with a buckle width of 72mm. The purpose of this study was to review the number of appropriately placed pelvic binders in the prehospital setting and to design a simple way for first-responders to quickly and effectively place pelvic binders.
A total of 209 pelvic radiographs with visible pelvic binders were identified on the Princess Alexandra Hospital’s Picture Archiving and Communication System (PACS). Two radiographs were excluded due to poor image quality. The distance of the binders and the trochanters were measured in millimetres from the midpoint of the greater trochanters to the midpoint of the pelvic binder buckle. Correct placement was defined by drawing two straight lines between the superior and inferior border of both greater trochanters. Three groups were attained based on the above criteria – trochanteric, partially-trochanteric and non-trochanteric. 122 binders (58.94%) were trochanteric. On average, trochanteric binders were 14.5mm from the greater trochanters in either direction whereas non-trochanteric binders were 50 millimetres away. Partially placed binders were 28mm away on average.
Pelvic binder misapplication is common, potentially causing
unsatisfactory fracture reduction and haemorrhage control.
An effective pelvic binder should be within 15 millimetres
of the greater trochanters in either direction. The mons
pubis can be used as a simple anatomical landmark.
1. Bottlang M, Krieg J, Mohr M, Simpson T, Madey S. (2002). Emergent management of pelvic ring fractures with use of circumferential compression. The Journal of bone and joint surgery. American volume. 84-A Suppl 2. 43-7.
2. Clinical Quality and Patient Safety Unit, Queensland Ambulance Service. Clinical Practice Procedures:Trauma/Pelvic circumferential compression device. April 2016
‘TO SCAN OR NOT TO SCAN’ IN THE TRAUMA SETTING – A RETROSPECTIVE STUDY Teresa Holm1, A. Xie1, Li C Hsee1
1. Auckland City Hospital, Grafton, Auckland, New Zealand
Successful care of patients with abdominal trauma depends on maximizing the identification of injuries necessitating surgical intervention without placing the patient at risk for nontherapeutic laparotomy. It is widely held by trauma surgeons that total-body computed tomography (CT) scanning provides one of the key modalities for assessing the threshold for surgery.
However the indiscriminate use of CT scans can cause radiation overdose and is not justified in patients with minor injuries. In an effort to begin to investigate these issues we have conducted a retrospective audit of trauma laparotomies and laparoscopies at Auckland City Hospital (New Zealand) from 2008 to 2017. We found that the average number of operative interventions per year was 36 (SD 11.75) but with a decreasing trend during this time period. The number of operations that resulted in an outcome of nontherapeutic laparotomy also showed a decreasing trend with maximum of 24 in 2008 to a minimum of 4 in 2017. These decreasing trends are associated with increased use of CT abdominal-pelvis scans during this period. We will present data testing the hypothesis that CT scanning prior to emergency surgery has decreased the rate of negative laparotomy/laparoscopy thereby improving outcomes by decreasing
in-hospital-stays and morbidity and mortality.
IDENTIFYING AREAS FOR IMPROVEMENT IN PAEDIATRIC TRAUMA CARE USING PEER-REVIEWKate Curtis3, 1, 2, Rebecca Mitchell4, Belinda Kennedy1, Andrew Holland6, 5, Gary Tall7, Soundappan Sannappa Venkatraman6, 5, Brian Burns7, 6, Stuart Dickinson8, Allan Loudfoot7, Kellie Wilson9, Tona Gillen10, Holly Smith11, Michael Dinh6, 12, 13, Timothy Lyons14
1. Susan Wakil School of Nursing and Midwifery, The University of Sydney, Sydney, New South Wales, Australia
2. Illawarra Shoalhaven Local Health District, Wollongong, New South Wales, Australia
3. The George Institute for Global Health, Sydney, New South Wales, Australia
4. Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
5. The Children’s Hospital at Westmead, Sydney, New South Wales, Australia
6. Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
7. NSW Ambulance, Sydney, New South Wales, Australia
8. Human Risk Solutions, Melbourne, Victoria, Australia
9. Sydney Children’s Hospital, Sydney, New South Wales, Australia
10. Lady Cilento Children’s Hospital, Brisbane, Queensland, Australia
11. Northern Sydney Local Health District, Sydney, New South Wales, Australia
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12. NSW Institute of Trauma and Injury Management, Sydney, New South Wales, Australia
13. Sydney Local Health District, Sydney, New South Wales, Australia
14. Department of Forensic Medicine, Newcastle, New South Wales, Australia
Background: There is known variability in the quality of
care delivered to injured children and identifying where care
improvement can be made is critical. The aim was to review paediatric trauma cases, to identify factors contributing to clinical incidents.
Methods: Medical records were reviewed at three NSW Paediatric Trauma Centres for children <16 years requiring intensive care, or with an injury severity score of >9, or who die following injury between July 2015 and September 2016. Records were peer-reviewed where nurse surveyors identified they potentially did not meet the expected standard of care, or the child died following the injury. A multidisciplinary panel conducted the peer-review using a major trauma peer-review tool. Records were reviewed independently, then discussed to establish consensus.
Results: Forty-one medical records were peer-reviewed. The mean (SD) age was 6.9 (5.4) years, the median ISS was 25 (IQR 16 - 30). In 83% of records, staff actions were identified to contribute to events, with 56% of these skill-based error a determined cause. The peer-review identified a combination of clinical (85%), organisational systems (51%) and communication (12%) problems contributed to difficulties in care delivery.
Conclusion: The peer-review of paediatric trauma cases assisted to identify contributing factors to clinical incidents in paediatric trauma care. This information will be useful to identify areas for improvement in health service
delivery to children sustaining severe injury.
REFINEMENT OF AN EVIDENCE-INFORMED CARE BUNDLE FOR BLUNT CHEST INJURY
Sarah Kourouche1, Belinda Munroe1, 2, Thomas Buckley1, Kate Curtis1, 2, 3
1. Susan Wakil Faculty of Nursing, University of Sydney, Camperdown, New South Wales, Australia
2. Emergency Services, Wollongong Hospital, Illawarra Shoalhaven Local Health District, Wollongong, New South Wales, Australia
3. The George Institute for Global Health, Sydney, New South Wales, Australia
Background: Blunt chest injuries (BCI) are associated with high rates of morbidity and mortality. There are many interventions for BCI which may be able to be combined as a care bundle for improved and more consistent outcomes.
Objective: To review and integrate the BCI management interventions to refine a BCI care bundle.
Methods: A structured search of the literature was conducted from 1990–April 2017 to identify studies evaluating interventions for patients with BCI. Databases MEDLINE, CINAHL, PubMed and Scopus . A two-step data extraction process was conducted using pre-defined data fields. Each study was appraised using a quality assessment tool, scored for level of evidence, then data collated into categories. Interventions were also assessed using the Acceptability, Practicability, Effectiveness/cost-effectiveness, Affordability, Safety/side-effects, Equity (APEASE) criteria then integrated to develop a BCI care bundle.
Results: The search yielded 1541 articles of which 81 were included in the final analysis. Interventions that improved BCI outcomes were grouped into three categories; respiratory intervention, analgesia and surgical intervention. Respiratory interventions included continuous positive airway pressure and high flow nasal oxygen. Analgesic interventions included regular multi-modal analgesia and paravertebral or epidural analgesia. Surgical fixation was supported for use in moderate to severe rib fractures/BCI. Interventions supported by evidence and that met APEASE criteria were combined into a BCI care bundle with four components: respiratory adjuncts, analgesia, complication prevention, and surgical fixation.
Conclusions: The key components of a BCI care bundle are
respiratory support, analgesia, complication prevention
including chest physiotherapy and surgical fixation.
A LEVEL ONE AUSTRALASIAN TRAUMA CENTRE’S FIVE YEAR EXPERIENCE OF TRAUMATIC URETHRAL INJURIES
Jan Fletcher1, 2, 3, Veeresh Aukhojee1, Thomas O’Dwyer4, Kerrianne Watt2, Katherine Martin1, Dee Nandurkar3, Jeremy Grummet,1, Peter Royce1, Max Esser1, Henry H.I Yao1
1. Alfred Hospital, Melbourne, Victoria, Australia
2. James Cook University, Townsville, Queensland, Australia
3. Monash Medical Centre, Melbourne, Victoria, Australia
4. Monash University, Melbourne, Victoria, Australia
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Background: Review and understand current
epidemiological trends in the patient journey at a level
one trauma centre, having sustained a traumatic urethral
injury. To highlight current imaging investigations and
subsequent multidisciplinary management practices
being employed in treating a multi-trauma patient.
Methods: The TraumaNET database was screened
between January 2009 and March 2014. Demographics,
clinical presentation, diagnostics and management were
recorded and cross-linked with medical records
Results: Thirty-four patients sustained a urethral injury,
for which 94% was a result of blunt trauma. In total, 97%
were categorised as a major trauma, with 88% sustaining
a grade 5 urethral injury and 85% sustaining a concurrent
pelvic fracture. In depth analysis of subsequent
investigation modalities, management and the patient
journey were assessed with respect to current guidelines.
Conclusion: Current management guidelines for urethral
injuries is based on Grade B evidence or less, with the majority of data being generated from the Northern Hemisphere where there is a greater incidence of penetrating trauma. The importance of consistent, systematic and time-critical approach to trauma care
is critical in contemporary practice in order to improve
clinical outcomes.
THE RISE AND CHANGING NATURE OF THORACIC INJURIES AMONG THE MAJOR TRAUMA POPULATION
Noha NF Ferrah1, Ben BB Beck2, Belinda BG Gabbe2, Peter PC Cameron2
1. Monash University, Southbank, Victoria, Australia
2. Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
Introduction: The trauma population is older and
increasingly presents following low-energy impacts.
However, it is unknown whether this trend also affects
thoracic trauma. This study aimed to examine the trend in
incidence, mechanism and type of serious thoracic injuries
over a 10-year period.
Methods: A retrospective review of all hospitalised
adult (≥16 years) major trauma patients with serious
(Abbreviated Injury Scale score ≥3) thoracic trauma, was
conducted using data from the population-based Victoria
State Trauma Registry from 2007 to 2016. Poisson
regression was used to determine whether the incidence,
mechanism and type of injury had changed over time.
Results: Over the 10-year study period, there were
8805 cases of major thoracic trauma, of whom 53% had
isolated thoracic injuries. Compared to those with injuries
to multiple body regions, patients with isolated thoracic
injuries were more frequently aged above 65 years (31%
vs 22%), and more often sustained injury from low falls
(12% vs 5%). The population-adjusted incidence of
thoracic injury increased by 8% per year (incidence rate
ratio (IRR)=1.08; 95% confidence interval (CI):1.07-1.09).
This rise was also observed across all mechanisms of
injury and age groups. Furthermore, the proportion of
major trauma patients with isolated thoracic injuries
increased by 6% per year (IRR=1.06; 95% CI:1.05-1.07),
which was largely driven by increases in the proportion of
skeletal chest only injuries.
Conclusions: The nature of thoracic trauma is changing,
and increasingly involves older and more vulnerable
patients, following low energy mechanisms.
CONCURRENT SESSION 12: FREE PAPERS-OUTCOMES
REVIEWING PREHOSPITAL TRAUMA DEATHS
Ben Beck1, Karen Smith1, 2, 3, Eric Mercier1, 4, Peter Cameron1,
5
1. Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
2. Department of Community Emergency Health and Paramedic Practice, Monash University, Melbourne, Victoria, Australia
3. Centre for Research and Evaluation, Ambulance Victoria, Doncaster, Victoria, Australia
4. Laval University, Quebec City, Quebec, Canada
5. Emergency and Trauma Centre, The Alfred, Melbourne,
Victoria, Australia
Introduction: This study aimed to conduct detailed
reviews of prehospital and early in-hospital trauma deaths
to identify opportunities to improve the system of care.
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Methods: We performed a retrospective review of
prehospital and early in-hospital (<24 hours) trauma
deaths following a traumatic out-of-hospital cardiac
arrest (OHCA) that were attended by Ambulance Victoria
(AV) between 2008 and 2014. Data from the Victorian
Ambulance Cardiac Arrest Registry (VACAR) were linked
with coronial data from the National Coronial Information
System and, for patients transported to hospital, to the
Victorian State Trauma Registry.
Using a multidisciplinary expert panel review methodology,
a detailed review of each case was conducted to evaluate
whether a proportion of these deaths were potentially
preventable or preventable and to identify opportunities
for improvement in the system of care provided to trauma
patients.
Results: Over the study period, there were 2,759 trauma-
related deaths attended by AV. Of the 777 patients
that received attempted resuscitation, 113 cases had
full autopsies and were deemed to have ‘survivable’
anatomical injuries. Of these, there were 90 (80%) deaths
that were considered to be non-preventable, 19 (17%)
that were considered to be potentially preventable and
4 (3%) preventable deaths. Potentially preventable or
preventable deaths represented 7% of cases that had
attempted resuscitation from paramedics.
Conclusions: No systematic problems were identified.
Rather, we identified a number of specific circumstances
in which the system of care provided to the patient was
suboptimal. The identification of these issues highlights
opportunities to make incremental improvements to
reduce trauma mortality.
TRAUMA CALL RATIO: A NEW ROYAL AUSTRALASIAN COLLEGE OF SURGEONS PROCESS INDICATOR IN TRAUMA CAREGrant Christey1, 2, 3, Louise Niggemeyer3, 4, 5, Joseph Mathew3, 4, 5, Mark Fitzgerald4, 5, Alex Olesson4
1. Waikato District Health Board, Hamilton, New Zealand
2. Waikato Clinical School, Hamilton, New Zealand
3. RACS Trauma Quality Improvement Subcommittee, East Melbourne, Victoria, Australia
4. National Trauma Research Institute, Melbourne, Victoria, Australia
5. Monash Health, Melbourne, Victoria, Australia
The trauma reception and resuscitation of patients with
severe or multiple injuries into hospital is considered
paramount to the provision of optimal trauma care. With
each hospital creating local trauma call criteria the challenge
for population based registries is identifying a trauma call
process of care indicator that applies across a dataset.
The Royal Australasian College of Surgeons (RACS) Trauma
Quality Improvement Subcommittee has developed
binational process indicators for trauma care, including a
new concept of Trauma Call Ratio for patients with an Injury
Severity Score (ISS) >12.
The trauma call ratio describes a simple equation where the
numerator is the number of trauma calls in patients with an
ISS>12 divided by the denominator, the number of patients
with ISS>12. In one Australasian Level 1 Trauma Centre
case series of 8000 consecutive major trauma patients
over 6 years, the Trauma Call Ratio was 84%.
Given the expectation from the RACS Trauma Verification
Subcommittee that trauma receiving facilities all require a
24/7 trauma call response, it is hoped that the trauma call
ratio, although arbitrary in nature, will be a useful indicator
of trauma reception for major trauma patients. Currently,
Trauma Call is not a data point of the Binational Australasian
trauma minimum dataset which is up for review in 2018.
Until this criterion is added, we recommend local trauma
registries identify their trauma call ratio and contribute to
the establishment of Australasian norms.
INCREASING NUMBER OF HOSPITALIZED BICYCLE INJURIES DURING 2005–2016
Ingar Næss1, 2, Pål Galteland3, Nils Oddvar Skaga4, Torsten Eken2, 4, Eirik Helseth1, 2, Jon Ramm-Pettersen1
1. Department of Neurosurgery, Oslo University Hospital, Ullevål, Oslo, Norway
2. Faculty of Medicine, University of Oslo, Oslo, Norway
3. Department of Maxillofacial surgery, Oslo University Hospital, Ullevål, Oslo, Norway
4. Department of Anesthesiology, Oslo University Hospital,
Ullevål, Oslo, Norway
Introduction: Norwegian authorities encourage commutes by
bicycle in order to improve public health and reduce pollution.
The present research on the consequences of such a shift in
the mode of transport is sparse. As our contribution to this
debate, we have studied trends in the treatment of bicycle
injuries at Oslo University Hospital, Ullevål (OUH-U).
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Methods: Data was collected from the OUH-U Trauma
Registry. We identified patients treated after sustaining a
bicycle injury between 2005 and 2016.
Results: A total of 1570 patients were identified. The
mean age was 39 (range 3 – 94); 72% were males. The
majority of injuries occurred during daytime, peaking at
8 am and 5 pm. 43% wore a helmet at the time of injury.
The annual number of admitted bicycle injuries increased
from 79 in 2005 to 187 in 2016. In Oslo the incidence
of hospitalized injuries to OUH-U was 9.8 per 100 000
inhabitants in 2005 and 16.8 in 2016. Median ISS 10
remained unchanged in the study period. 34% suffered
from major trauma (ISS ≥16). 29% had head, 9% neck,
and 16% thoracic injuries with AIS ≥3. Severe traumatic
brain injury classified as GCS <9 was seen in 7%. The
median length of hospitalization was 3 days, and 38% had
surgery in one or more body regions. The 30-day mortality
was 2.3%.
Conclusions: The number of admitted bicycle injuries to
OUH-U is increasing. Bicycle injuries can be devastating,
and we believe they deserve more public attention in order
to promote road safety.
THE IMPACT OF FRAILTY IN CRITICALLY ILL TRAUMA PATIENTS: A PROSPECTIVE OBSERVATIONAL STUDY
Claire J Tipping1, 2, Emily Bilish3, Anne E Holland1, 4, Meg Harrold5, Terry Chan1, Carol L Hodgson1, 2
1. Physiotherapy Department, Alfred Hospital, Prahran, Victoria, Australia
2. DEPM, Monash Uni, Melbourne, Victoria, Australia
3. Physiotherapy, Royal Perth Hospital, Perth, Western Australia, Australia
4. Physiotherapy, LaTrobe University, Melbourne, Victoria, Australia
5. Curtin University, Perth, Western Australia, Australia
Background: The outcomes of older trauma patients are usually evaluated in relation to age and co-morbidities and the impact of frailty has not been explored.
This study aims to determine the impact of frailty in trauma ICU, with respect to mortality and function.
Methods: A multi-centre, prospective observational study of patients aged ≥50 years, admitted to ICU following trauma. Frailty was determined using the Frailty Phenotype (FP).
Results: One hundred and thirty eight patients were enrolled, mean age 67 ± 10, APACHE II 15 ± 6 and injury severity score (ISS) 21 ± 10. Frailty was identified in 22% of patients.
Compared to non-frail patients, the patients with frailty were significantly less injured (ISS) (p=0.001), required less operations (p=0.004) and mechanical ventilation (0.04) and were more mobile on ICU discharge (ICU mobility scale, p=0.03), however they were older (p=0.001), had more co-morbidities (p=0.0001) and higher APACHE II scores (p=0.01).
Patients with frailty had significantly higher mortality at ICU (p=0.001) and hospital discharge (p<0.001). Frailty was independently associated with mortality six months post injury (OR 5.9, 95% CI 1.9-18.1, p=0.002) and patients with frailty had poorer global function (GOSE) at 6 months (frail 3 (1-5), non-frail 6 (4-7), p=0.0002).
Conclusion: In a trauma ICU cohort, frailty is a predictor
of short and long-term mortality and long-term function.
Identifying frailty in trauma patients admitted to ICU
will determine patients at higher risk of a poor outcome,
which may result in treatment modification and improve
discharge planning.
PREVALENCE AND MANAGEMENT OF MILD TRAUMATIC BRAIN INJURY AT THE ROYAL MELBOURNE HOSPITAL: A RETROSPECTIVE AUDIT
Eloise Thompson1, Marlena Klaic1, Celia Marston1, Timothy Milroy1
1. Occupational Therapy, The Royal Melbourne Hospital, Parkville, Victoria, Australia
Aim: To explore the incidence and management of mild
traumatic brain injury (TBI) patients admitted to the Royal
Melbourne Hospital (RMH).
Background: In 2017, 1,126 individuals presented to
RMH with a potential mild TBI. Ongoing symptoms can
significantly impact a patient’s return to daily activities.
International guidelines recommend standardised
post traumatic amnesia (PTA) assessment, written
education and follow up to support return to ADLs. These
international guidelines are not currently utilised at RMH
and the long-term outcome for this cohort is unknown.
Methods: Retrospective medical record audit was
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conducted. Participants were identified through coding,
indicating potential mild TBI between August 2016 and
February 2017. Demographic and clinical outcome data
was manually collected including length of stay (LOS),
discharge destination, related readmissions, follow up
referrals, completion of PTA assessment, provision of
education, and occupational therapy input. Descriptive and
statistical analyses were undertaken including multivariate
regression to detect impact of variables on outcomes.
Results: 278 files were screened with confirmed mild TBIs.
Preliminary data analysis indicates an average LOS of 2
days, less than one third had a completed standardised
PTA assessment on record or documentation of education,
and inadequate TBI-specific follow-up. A small percentage
of this population have recorded mild TBI related
readmissions warranting further exploration.
Conclusion: There is a high incidence of mild TBI
admissions at RMH however current management does
not align with best practice, particularly in assessment
and post discharge follow up. Results will inform a mixed-
method study planned to better understand the long term
patient outcomes.
OUTCOMES AND COSTS OF SEVERE LOWER EXTREMITY INJURY
Belinda Gabbe1, Pam Simpson1, Lara Kimmel2, Melissa Hart1, Andrew Oppy3, Elton Edwards4
1. Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
2. Physiotherapy Department, The Alfred, Melbourne, Victoria, Australia
3. Orthopaedic Surgery, Royal Melbourne Hospital, Parkville, Victoria, Australia
4. Orthopaedic Surgery, The Alfred, Melbourne, Victoria, Australia
Background: Complex fractures of the femur and tibia are
challenging to manage and can require a decision between
retaining the limb (salvage) or amputation. The aim of this
study was to describe the health status outcomes and
costs of severe, complex fractures of the femur and tibia.
Methods: Adult (>15 years) patients with i) fractured
femur or tibia and a Mangled Extremity Severity Score
(MESS) ≥7, or ii) traumatic amputation, were extracted
from the Victorian Orthopaedic Trauma Outcomes Registry
(January 2007 to June 2016). Cases were grouped into
traumatic amputation, surgical amputation, or limb salvage.
6, 12 and 24-month EQ-5D-3L outcomes were compared
between groups using multivariable mixed effects models.
Treatment and estimated lifetime costs were obtained from
the third party, no fault insurer for road traffic injury (RTI).
Results: 114 patients were included; 55 salvages, 41
traumatic amputations and 18 surgical amputations. The
mean (SD) age of patients was 44.3 (16.9) years, 82% were
male, and 83% were road traffic injuries. The adjusted odds
of reporting problems with usual activities (AOR 0.25, 95%
CI: 0.04, 0.87), and anxiety/depression (AOR 0.13, 95% CI:
0.02, 0.86) were lower for surgical amputation compared to
salvage. Mean estimated lifetime claim costs for RTI cases
were $942,379 for salvage cases; $1,105,832 for traumatic
amputations and $1,378,066 for surgical amputation cases,
respectively. Costs were comparable between the groups
after adjustment for potential confounders.
Conclusions: There was no clear cost or functional benefits from limb salvage over surgical amputation using the
outcomes assessed in this study.
TRAUMA OCCUPATIONAL THERAPY AT THE ROYAL DARWIN HOSPITAL: A UNIQUE MODEL OF CARE
Erica Bleakley1
1. National Critical Care and Trauma Response Centre, Tiwi, Northern Territory, Australia
The Royal Darwin Hospital Trauma Service is a consultative
service that utilizes a case coordination model to ensure
a high quality of care and outcomes for trauma patients
admitted to the Royal Darwin Hospital. The clinical arm of
the service comprises a Director of Trauma, Trauma Fellow,
Clinical Nurse Consultants, a Trauma Social Worker and
Trauma Occupational Therapist.
The Trauma OT is embedded within the Trauma Service as
a permanent, non-rotational senior clinician. The Trauma
OT is required to perform as a ‘one stop shop’ for the OT
needs of all patients admitted under the Trauma Service,
meaning the role demands proficiency in the assessment
and management of the spectrum of traumatic brain injury,
burn and upper limb injuries, and other orthopaedic and
surgical trauma injuries. Continuity of care is ensured with
the Trauma OT retaining responsibility for Trauma patients
regardless of their moving wards in the hospital.
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The Trauma OT, as a core member of the RDH Trauma Service, serves as a unique example of a model of care for OT in the acute hospital setting. In the absence of dedicated stand-alone trauma, neurosurgical, brain injury or burn units, this model of care ensures comprehensive clinical expertise for the occupational therapy management of complex multi-trauma patients that is
especially valuable in light of the unique geographic and
demographic context of the Royal Darwin Hospital.
COMPARISON OF FUNCTIONAL CAPACITY INDEX SCORING WITH ABBREVIATED INJURY SCALE 2008 SCORING IN PREDICTING 12-MONTH SEVERE TRAUMA OUTCOMES
Cameron S Palmer1, 2, Peter A Cameron2, 3, Belinda J Gabbe2, 4
1. Royal Children’s Hospital Melbourne, Parkville, Australia
2. Dept Epidemiology & Preventive Medicine, Monash University, Melbourne, Australia
3. Emergency Medicine, Hamad Medical Corporation, Doha, Qatar
4. Farr Institute, Swansea University Medical School, Swansea University, Swansea, United Kingdom
The vast majority of severely injured patients survive their
injuries. Routine monitoring of long-term outcomes for
these patients is desirable, although few regions have
implemented this. Appended to the 2008 Abbreviated Injury
Scale (AIS), the Functional Capacity Index (FCI) potentially
offers a widely-available means to predict these outcomes.
This study aimed to determine the extent to which AIS-
based and FCI-based scoring could add to a simple predictive
model of 12-month function, and to evaluate methods of
combining FCI scores for multi-trauma patients.
Adult major and orthopaedic trauma patients injured
between January 2007 and June 2015 were drawn
from the Victorian State Trauma Registry. Patients
were followed up at 12 months via telephone interview
including the Glasgow Outcome Scale - Extended, the
EQ-5D-3L and return to work status. A base model of age
and gender was used; a battery of three AIS-based scores
(including ISS and NISS), three FCI-based scores and a
simple injury count were added to this model in turn.
20,813 surviving patients had functional outcomes
recorded. Patients were 70% male; 47% were injured in
transport accidents, and only 4% of patients sustained
penetrating injury. Outcome predictions using the base
model varied substantially across measures, with some
little better than chance. Irrespective of the method
used, adding injury severity to the model significantly,
but only slightly improved model fit. No method of injury
severity assessment clearly outperformed any other.
Although the FCI was designed to provide for functional
outcome prediction after injury, it performed similarly to
the mortality-biased AIS.
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CYCLISTS AND HELMETS – EFFECTIVE OR FALSE SENSE OF SECURITY
Vindya Abeysinghe, Sudhakar Rao
Cycling provided major benefits to individuals and communities through better health outcomes and benefits to the environment.
The safety of cyclists is paramount and injury prevention measures include changes to road rules and adherence to personal safety by cyclists. In 2014 there were 6642 hospitalisations due to cyclling injuries, of which 1051 were “high threat to life” injuries.
The use of helmets as primary prevention of traumatic brain injury is supported by the Royal Australasian College of Surgeons and the American College of Surgeons. Anti-helmet lobby groups continue to challenge the status quo. Contemporaneous and local data is vital in providing a sound scientific basis to the stand taken by health advocates.
Hypothesis: Cyclists without helmets have more serious intracranial injuries, and suffer with more radiological lesions on CT scan.
Method: Data is collected in a prospective manner into the Trauma Registry at Royal Perth Hospital. The data for all cyclists was extracted from this database and analysed for a period of ten years. Cyclists who died at the scene were not analysed. Comparisons between helmeted and non-helmeted populations were made for intracranial injuries, and for cervical spine injuries.
Results: Helmets reduce the severity of intracranial injuries and also reduce the number of intracranial lesions seen on CT scan.
Helmets are a vital part of Primary Injury Prevention for Cyclists.
Ref: BITRE 2014 report
NOT A NANNY STATE – THE ETHICAL JUSTIFICATION FOR INJURY PREVENTION PUBLIC HEALTH POLICIES
Keith Amarakone1
1. Royal Children’s Hospital, PARKVILLE, Victoria, Australia
Public health is widely accepted as those collective or
social actions necessary to assure the conditions that
allow health to flourish. The desire to avoid a “nanny
state” is rooted in the notion that public health policies
unjustly infringe on individual liberties. Health care
practitioners involved in trauma care should have a robust
understanding of the ethical justifications for public health
care policies that aim to reduce injury – in particular those
concerned with injury prevention in children. In particular,
I submit that where public health policy regarding injury
prevention is responsive to the needs of the population
concerned they can be seen to augment autonomy and
personal freedom rather than their common interpretation
as paternalistic overreach by a “nanny state”.
BLOOD ALCOHOL LEVEL IS NOT AFFECTED (DILUTED) BY LARGE VOLUME RESUSCITATION OR TRANSFUSION. Megge Beacroft, Sudhakar Rao
Alcohol and other mind altering substances affect the
clinical assessment of a patient’s neurological status,
ability to report or respond to clinical assessments, and
furthermore may contribute to disordered physiological
responses to haemorrhage.
A predictable metabolic rate and excretion rate of alcohol
is useful to clinicians in being able to decide when a
patient may be sober enough for reliable assessment of
symptoms of head injury in particular, and also of other
minor injuries that may have otherwise been undiscovered
in a state of inebriation.
There are known factors that contribute to slightly
different rates of alcohol distribution and metabolism
(Body mass, gender, chronic alcohol consumption). What
is less well known is whether trauma and resuscitation
with intravenous fluids, or massive exchange transfusion
alters the Blood Alcohol levels.
Method: We retrospectively reviewed patients who were
admitted to the trauma service with high blood alcohol levels to determine the rate of change in Blood Alcohol levels in patients who received with various amounts of intravenous resuscitation.
Conclusion: Large volume resuscitation does not affect the Blood Alcohol level in a trauma patient. A predictive
graphical reference chart can be used to predict when
a trauma patient is likely to be “sober” enough for
assessment and discharge from hospital emergency rooms.
Poster Abstracts
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TRENDS IN PREHOSPITAL TRAUMA DEATHS IN VICTORIA
Ben Beck1, Karen Smith1, 2, 3, Eric Mercier1, 4, Peter Cameron1, 5
1. Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
2. Centre for Research and Evaluation, Ambulance Victoria, Doncaster, Victoria, Australia
3. Department of Community Emergency Health and Paramedic Practice, Monash University, Melbourne, Victoria, Australia
4. Laval University, Quebec City, Quebec, Canada
5. Emergency and Trauma Centre, The Alfred, Melbourne, Victoria, Australia
Introduction: The aim of this study was to provide an
epidemiological overview of prehospital trauma deaths
over a 7-year period.
Methods: We performed a retrospective review of
prehospital trauma deaths over the period of 2008 to
2014 in Victoria, Australia. Data was extracted from the
Victorian State Trauma Registry and the National Coronial
Information System. Poisson regression was used to
investigate temporal trends in incidence rates.
Results: Over the seven year study period, there were 5,793
prehospital trauma deaths in Victoria with an overall crude
incidence of 14.9 deaths per 100,000 population, with an
average of 828 prehospital trauma deaths per year. These
trauma deaths were mostly male (76%), occurred in major
cities (59%), and resulted from intentional self-harm events
(50%), unintentional events (43%), assaults (4%) and other
and unknown events (3%).
The incidence of prehospital trauma deaths declined 2% per
year from 2008 to 2014 (incidence rate ratio (IRR) = 0.98;
95%CI:0.97,1.00; P=0.017). Overall, deaths from transport
events declined 4% per year (IRR = 0.96; 95%CI:0.94,0.98;
P=0.001) while the incidence of deaths resulting from
hangings did not change over the study period (IRR = 1.01;
95%CI:0.99,1.04; P=0.234). As a result, the incidence of
hangings in 2014 (5.0 per 100,000 population) was greater
than of transport events (4.3 per 100,000 population).
Conclusions: While declines were observed in the
incidence of all prehospital trauma deaths over the study
period, many of these deaths are preventable and these
data can be used to drive injury prevention strategies.
CHARACTERISTICS AND OUTCOMES OF ADULT TRAUMA PATIENTS ATTENDED BY ST JOHN AMBULANCE PARAMEDICS IN METROPOLITAN PERTH
Elizabeth Brown2, 1, Hideo Tohira2, 3, Paul Bailey2, 4, 1, Judith Finn2, 3, 5, 1
1. St John Ambulance Western Australia, Belmont, Western Australia, Australia
2. Prehospital Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery and Paramedicine, Curtin University, Bentley, Western Australia, Australia
3. Division of Emergency Medicine, The University of Western Australia, Crawley, Western Australia, Australia
4. Emergency Department, St John of God Murdoch Hospital, Perth, Western Australia, Australia
5. School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
Objective: To describe the epidemiology of adult trauma in
metropolitan Perth, Western Australia, treated by ambulance
paramedics.
Methods: Using the St John Ambulance Western Australia
(SJA-WA) database and WA death data, a retrospective
cohort study of trauma patients aged ≥16 years attended by
paramedics in metropolitan Perth between 2013 and 2016
was undertaken. Comparisons of age, sex, mechanism of
injury and acuity level were made between patients who died
prehospital (immediate deaths), on the day of injury (early
deaths), within 30-days (late deaths) and those who survived
longer than 30-days (survivors). Trauma incidence and
30-day mortality rates were also calculated and prehospital
interventions reported.
Results: There were 97,724 cases included in the study. Of
these 2,183 patients died within 30-days (n=2,183/97,724,
2.2%). Motor vehicle accidents were responsible for the
most immediate and early deaths (n=98/203, 48.3% and
n=72/156, 46.2% respectively). A statistically significant
increase in trauma incidence was observed (from 1,466 to
1,623 per 100,000 population-year p=<0.001). Low acuity
injuries accounted for the majority of transports (acuity
levels 3 to 5 n=60,594/79,887, 75.8%) with high-acuity
accounting for just 2.7% (n=2,176/79,997). Insertion
of intravenous catheters occurred in more than 30% of
cases (n=25,060/80,643, 31.1%) with the most frequently
performed intervention being the analgesia administration
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(n=32,333/80,643, 40.1%). Endotracheal intubation and
other advanced life support interventions were performed in
less than 1% of patients.
Conclusions: The incidence of trauma increased over the
study period. Most patients had low-acuity injuries, high-acuity
trauma occurring only infrequently. This has implications for
paramedic skill retention.
THE DEVELOPMENT OF A MAJOR TRAUMA RECOVERY COORDINATOR POSITION: A PILOT PROJECT
Sara Calthorpe2, 1, Lara A Kimmel2, 3, Mark Fitzgerald1, William Veitch3, Belinda Gabbe3
1. The Alfred Trauma Service and National Trauma Research Institute, The Alfred, Melbourne, Victoria, Australia
2. The Alfred Physiotherapy Department, Melbourne, Victoria, Australia
3. Department of Epidemiology and Preventive Medicine,
Monash University, Melbourne, Victoria Australia
Background: Previous research involving Victorian Major
Trauma Services (MTS) has described patient dissatisfaction
with the discharge process and coordination of follow-up
care. A two-year pilot Major Trauma Recovery Coordinators
(MTReC) to the Alfred Trauma Service was established to
improve the discharge planning and post-discharge care
coordination of trauma patients.
Methods: The MTReC role was specifically designed to include
meeting with patients whilst in-hospital, follow up phone
calls following discharge at set timepoints, and providing a
single point of contact for patients after leaving the hospital.
A custom-built database was established to capture detail
about patient/family contacts and MTReC actions.
Results: During the first 12 months, 550 major trauma
patients were coordinated by the MTReC. Direct patient
interaction was predominant, with 28% of cases
coordinated via proxy. For inpatients, 84% of issues
concerned patients not understanding their injuries and
medical management (34%); care instructions (32%) and/
or discharge plans (49%). Following discharge, issues
related to outpatient appointments (45%) and concerns
including poor understanding of care instructions, pain
management and discharge processes were most common.
The MTReC received over 300 unscheduled phone calls,
relating to 183 different patients.
Summary: Establishing a MTReC service within trauma
centres is feasible and provides a single point of contact
for trauma patients throughout the continuum of care. The
key requirement of the MTReC was the provision of injury
education and advice, coordination of follow-up care,
and ensuring timely and efficient access to specialist
outpatient clinics. The MTReC pilot is being further
evaluated using qualitative and quantitative methods.
MEASUREMENT OF MOBILITY AND PHYSICAL FUNCTION IN HOSPITALISED TRAUMA PATIENTS: A SYSTEMATIC REVIEW OF INSTRUMENTS AND THEIR MEASUREMENT PROPERTIES
Sara Calthorpe1, 2, Lara A Kimmel1, 3, Melissa J Webb1, Belinda Gabbe3, Anne E Holland1, 4
1. The Alfred Physiotherapy Department, Melbourne, Victoria, Australia
2. The Alfred Trauma Service and National Trauma Research Institute, The Alfred, Melbourne, Victoria, Australia
3. Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
4. Alfred Health Physiotherapy Clinical School, La Trobe University, Melbourne, Victoria, Australia
Background: As trauma systems mature and the mortality
rate following trauma plateaus, it is important to measure
patient morbidity of which mobility and physical function are
key aspects. However the optimal instrument to measure
this in the acute hospital setting remains unclear.
Methods: A systematic review to identify and describe
mobility and physical function instruments scored by direct
patient observation, used in adult trauma patients in an
acute hospital setting was undertaken. Instruments that
were condition, disease or joint specific were excluded.
The COSMIN checklist was used to assess risk of bias
where relevant. Clinimetric properties were reported where
possible, including reliability, validity and responsiveness.
Results: 10,250 articles were identified with 35 eligible for
final review, including six different instruments. None had
been specifically designed for use in a trauma population.
The Functional Independence Measure (FIM) was most
commonly cited (n= 10 studies), with evidence for
construct validity, responsiveness and minimal floor/ceiling
effects (<3%). The modified Iowa Level of Assistance
(mILOA, n= 2 studies) was reliable and responsive, but
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ceiling effect ranged from 26% to 37%. Little clinimetric data were available for other measures
Discussion: Evidence from a small number of studies supports the use of the FIM and mILOA to measure mobility and physical function in trauma patients in the acute hospital setting, however comprehensive clinimetric data is lacking. Future research should investigate the reliability and validity of commonly used measures in defined trauma populations
to establish their usefulness in evaluating acute treatment
effectiveness and predict longer-term outcomes.
EARLY IN-REACH REHABILITATION FOR TRAUMA PATIENTS AT A MAJOR TRAUMA CENTRE - INITIAL EXPERIENCE
Teresa Boyle1, Sabina Bialkowski2, Kate Dale1, Don Campbell1, Martin Wullschleger1
1. Gold Coast University Hospital, Southport, Queensland, Australia
2. Griffith University, Southport, Queensland, Australia
Purpose: To present initial data and describe the model
of care of a novel clinical acute rehabilitation intervention
service with a focus on trauma patients. This service
provides multidisciplinary rehabilitation management on
acute wards prior to the conclusion of the acute episode
of care. Principle aims of the service are to reduce overall
length of stay; improve function at discharge from hospital;
reduce deconditioning; and facilitate comprehensive
discharge planning.
Methodology: A descriptive review of trauma patients
that have utilised the in-reach Rehabilitation Response
Team, (RRT) over a 24-month period, April 2016 to April
2018. Outcome scores including Functional Independence
Measure (FIM), De Morton Mobility Index, Patient Specific
Functional Scales as well as Injury Severity Score,
Demographics and length of stay are measured.
The multidisciplinary team is supervised by a rehabilitation
consultant and allied health team leader. Ongoing formal
and informal audit of workflow and outcomes is undertaken
to ensure the quality improvement of the service.
Results: Since hospital-wide RRT implementation, 86
Trauma patients (14 female, 72 male) with a mean age of
49 years have utilised the service over a 24-month period.
Mean length of stay on the program was 10.1 days and overall FIM efficiency was 1.59. Other relevant outcome
metrics, as well as referrer and patient feedback will also be presented. Challenges and positive achievements encountered throughout this process are reported.
Conclusion: We present the implementation of a novel in-reach rehabilitation service in the setting of acute trauma
at the Gold Coast University Hospital.
EXPERIENCE OF BLUNT CARDIAC INJURY IN A MAJOR TRAUMA CENTRE: A RETROSPECTIVE ANALYSIS
David Cheng1, Christopher Merrett1, Rodney Judson1
1. The Royal Melbourne Hospital, Parkville, Victoria, Australia
Background: Blunt cardiac injury is an uncommon
diagnosis however its importance remains, due to its
high association with mortality. The definition of blunt
cardiac injury remains very broad; ranging from mild cardiac
contusion with minimal sequela to ventricular rupture with
high mortality. Little has changed in diagnostic algorithms
in the last 15 years and the appropriate approach to
identify those with cardiac injury is largely unknown.
Methods: A single site retrospective cohort analysis was
conducted of all major trauma patients seen at the Royal
Melbourne Hospital, a level 1 trauma centre, from January
1997 to January 2018. Surgical outcomes and mortality
statistics were identified and retrospective review of the
diagnostic workup including both biochemical markers and
radiology were analysed.
Results: A retrospective chart review identified 108
patients with a diagnosis of blunt cardiac injury over a
22 year period. Analysis of the utility of serum troponins,
extended focussed assessment with sonography for
trauma (eFAST) scans, transthoracic echocardiography
and CT angiography was performed. There appears to
be a high false negative rate associated with eFAST
examinations. 30 patients were complicated by cardiac
arrest requiring cardiopulmonary resuscitation, 11
patients developed a cardiac arrhythmia and 3 patients
were complicated by acute myocardial infarction.
Conclusion: This study shows our experience of blunt
cardiac injury over a 22-year period in a single major trauma
centre. Blunt cardiac injury is still an uncommon diagnosis
however its risk of mortality remains high and appropriate
diagnostic algorithms to identify the correct pathology
quickly remains important.
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RETROSPECTIVE REVIEW OF TRAUMATIC THORACIC SPINE INJURIES: “ARE WE MISSING SOMETHING?”
Erasmia Christou1, Sana Nasim1, Sudhakar Rao1
1. State Major Trauma Unit, Royal Perth Hospital, Perth, Western Australia
Objective: A recent audit at a Level 1 Trauma Centre showed
that bowel and thoracic spine were the most commonly
missed blunt trauma injuries. The purpose of this study
was to determine the incidence of thoracic spinal injuries,
identify potential factors contributing to the failure of their
recognition and the consequences of such; this may help
guide us in suspecting and identifying future injuries.
Methods: A retrospective review of data from the trauma
registry was conducted from 2003 to 2015, and analysed
via the SPSS-V.22 program.
Results: 2760 patients with thoracic spine injuries were
identified; 129 (4.7%) of these patients had a missed
injury. The mean Injury Severity Score (ISS) was 17 +/- 12,
whilst the main causative mechanism was motor vehicle
crash followed by falls. Glasgow Coma Scale (GCS), age
and level of injury did not have any statistical significance
in contributing to missing an injury; ISS, mechanism and
neurology all played roles. 44% of patients with a missed
injury required bracing; none required surgery, nor did any die.
Conclusion: Thoracic spine injuries were missed in less
than 5% of patients; contributing factors included ISS and
mechanism of injury, but not level of injury or GCS. As the
number of trauma admissions increased over the years,
the incidence of thoracic spinal injuries also increased and
identification of missed injuries was subsequently higher.
We should therefore have a reasonable index of suspicion for thoracic spine injuries when we treat all high risk trauma
patients from motor vehicle crashes and falls.
SUDDEN ENDING OF LIFE – PALLIATIVE AND PASTORAL CARE
Ken Devereux1
1. Royal Perth Hospital, Perth, Western Australia, Australia
Trauma response is heavily oriented to medical
interventions but in spite of best efforts, positive
restoration of functional life is sometimes not possible.
Transition to comfort care and preparation for end of life
then becomes an urgent practicality. Medical personnel
may need to share space in order to facilitate palliative
care, pastoral care and possibly organ donation colleagues.
This change of emphasis in an acute setting has not
always occurred smoothly or in ways that are most
beneficial to the patient or the family members or to the
other staff involved in caring for the critical patient.
At a time when end of life care, euthanasia and the right to
self-determination with respect to dying are current topics
of public controversy and Western Australia is preparing
for parliamentary debate over possible changes to the law,
it is timely to recognize that within the hospital setting, there are frequent situations that require urgent decisions regarding critical choices of care management. What level of treatment or withdrawal of treatment is appropriate? What is the best way to offer pain relief and comfort? If the patient is not able to assess the situation and make a conscious and informed choice, who will? Who is available? How will they be informed and supported as next of kin and other closely involved people juggle hopes of
survival alongside realistic possibilities of severe disability
or death? How can staff be supported whilst handling
emotional situations that include caring for shocked, angry
or grieving relatives and friends?
ASSESSMENT OF THE IMPACTS OF THE OPTIMISED RECOVERY AFTER TRAUMA (ORAT) PROGRAM REPORTED BY MULTIDISCIPLINARY TEAM MEMBERS AT A MAJOR TRAUMA CENTRE
Jennifer Dorrian1, Damien Ah Yen1, Bronwyn Denize1, Michelle Tonks1, Jessica Steenson1, Kelsee Bax1, Annabelle Hastings1, Christo Creiffer1, Kelly Leatherland1, Grant Christey1, 2
1. Waikato District Health Board, Hamilton, New Zealand
2. University of Auckland, Hamilton, New Zealand
Increasing requirements for standardisation and
measurement of clinical processes impacting major trauma
patients are amplifying the need for efficient multi-
disciplinary care that consistently applies best practice to
these complex and vulnerable patients and their families.
Nurses and allied health professionals are central to the
daily delivery of care in these clinical settings by virtue
of their frequent contact with patients and their families,
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the knowledge acquired from those interactions, and the
depth of relationships they form as a result. The Optimised
Recovery After Trauma (ORAT) program is a clinical framework
designed to maximise collaboration of multi-disciplinary team
members through the use of a shared database containing
key elements of clinical care to be addressed during and
after admissions of major trauma patients to hospitals. The
information obtained in the ORAT program is used primarily to
support three clinical activities: the daily ward-round, regular
multidisciplinary meetings and comprehensive discharge
planning. Nurse and allied health professionals are primary
contributors to the ORAT database and the three clinical
activities it supports. We provide an assessment of the
impacts of the program on their work and on their patients
in the tertiary trauma centre where the ORAT program was
developed and tested. We hope that these experiences will
stimulate further discussion and development of similar
programs for the benefit of patients and their families in
trauma-receiving facilities in Australia and New Zealand.
A PROSPECTIVE REVIEW OF APPROACHES TO CERVICAL SPINE IMMOBILISATION PRACTICEIN A TERTIARY TRAUMA CENTRE
Andrew Coggins1, 2, Nargus Ebrahimi1, Ursula Kemp1, Kelly O’Shea1, Michael Fusi3
1. Emergency, Westmead Hospital, Sydney, New South Wales, Australia
2. Discipline of Emergency Medicine, Sydney Medical School, Sydney, New South Wales, Australia
3. The University of Birmingham, Birmingham, England
Background: A large number of trauma patients
presenting to the Emergency Department (ED) receive
Cervical Spine Immobilisation (CSI). However, there
is conflicting evidence regarding CSI, with some
evidence suggesting its harmful effects and also its
ineffectiveness in preventing inadvertent movements.
The objective of this study was to investigate current
practices, adherence to guidelines and the attitudes of
staff in relation to CSI.
Methods: We performed a mixed methods study in a
single tertiary referral centre. Prospective observational data were collected on both a cohort of patients (n=54) and through an interdisciplinary provider survey (n=156).
Results: In our patient cohort, the mean age was 50.6 years
and 72.2% were male. Patients presented with a variety of
mechanisms including Motor Vehicle Accidents (37.0%) and
Falls (40.7%). CSI was initiated prehospital in the majority
of cases (77.8%). The median time spent immobilised was
325 minutes (IQR 108-409). Overall, there was a 63.6%
reported compliance with local guidelines. Variations in
compliance were multifactorial but commonly associated
with conflicting approaches across disciplines.
Healthcare providers surveyed included nurses (29.5%),
doctors (44.2%) and paramedics (26.3%). Qualitative
content analysis revealed variance in staff approaches
to current best practice and their approaches to
standardised cases. There was a desire for a more uniform
approach to CSI clearance.
Conclusions: There was a marked variation in the
approach to CSI and use of guidelines in the ED setting.
In conclusion, there is likely to be benefit from a more
standardised approach to CSI.
RADIOLOGICAL FINDINGS OF ABDOMINAL INJURIES OF THE SOFT TISSUES WITHIN SEAT BELT SYNDROME ON COMPUTED TOMOGRAPHY (CT)
Claire Elliot1, Derek Teh1, Liz Wylie1
1. Royal Perth Hospital, Perth, Western Australia, Australia
Publish consent withheld
VIDEO-TUBE THORACOSTOMY IN TRAUMA RESUSCITATION
Peter Finnegan1, 2, 3, Mark Fitzgerald1, 2, 3, De Villiers Smit1,
4, 5, Kate Martin1, 2, 3, Joseph Mathew1, 2, 3, Dinesh Varma6, Andrew Lim1, S Scott2, 5, Kim Williams1, 2, Yesul (Yen) Kim1,
2, 3, Biswadev Mitra1, 4, 5
1. National Trauma Research Institute, Prahran, Victoria, Australia
2. Alfred Trauma Service, The Alfred, Melbourne, Victoria, Australia
3. Central Clinical School, Monash University, Melbourne, Victoria, Australia
4. Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
5. Emergency and Trauma Centre, The Alfred, Melbourne, Victoria, Australia
6. Department of Radiology, The Alfred, Melbourne, Victoria, Australia
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Background: Complications related to incorrect positioning
of tube thoracostomy (TT) have been reported to be as high
as 30%. The aim of this study was to assess the feasibility
of flexible videoscope guided placement of a pre-loaded
chest tube, permitting direct intrapleural visualization and
placement (Video-Tube Thoracostomy [V-TT]).
Methods: A prospective, single centre, phase 1 feasibility
study with a parallel control group was undertaken. The
population studied were adult thoracic trauma patients
requiring emergency TT who were haemodynamically stable.
The intervention performed was V-TT. Patients in the control
group underwent conventional TT. The primary outcome
was tube position as defined by a consultant radiologist’s
interpretation of chest x-ray (CXR) or CT. The trial was
registered with ANZCTR.org.au (ACTRN: 12615000870550).
Results: There were 37 patients enrolled in the study - 12
patients allocated to the V-TT intervention group and
25 patients allocated to conventional TT. Mean age of
participants was 48 years (SD 15) in intervention group and
46 years (SD 15) years in the control group.
In the V-TT group all patients were male; the indications
were pneumothorax (83%), haemothorax (8%) and
haemopneumothorax (8%). The median injury severity score
was 23 (16-28). There were 1 insertional and 1 positional
complications.
Conclusion: V-TT was demonstrated to be a feasible
alternative to conventional thoracostomy and merits further
investigation.
EVALUATING RESUSCITATIVE BALLOON OCCLUSION OF THE AORTA (REBOA) FOR EXSANGUINATING TRAUMA RELATED HAEMORRHAGE IN AN ADULT AUSTRALIAN TRAUMA CENTERMark Fitzgerald1, 2, 3, Stephen Bernard4, 5, Robert Lendrum6, John Moloney7, 6, Smit De Villiers1, 4, 7, Joseph Mathew1, 2, 3, 7, C Nickson8, 9, R M Lin8, 10, May Yeung1, 2, Kate Martin1, 2, Adam Bystrzycki1, 4, Louise Niggemeyer1,
2, Biswadev Mitra1, 4, 7
1. National Trauma Research Institute, Prahran, Victoria, Australia
2. Alfred Trauma Service, The Alfred, Melbourne, Victoria, Australia
3. Central Clinical School, Monash University, Melbourne, Victoria, Australia
4. Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
5. Research, Ambulance Victoria, Melbourne, Victoria, Australia
6. Anaesthesia and Intensive Care, Royal Infirmary of Edinburgh, Edinburgh, Scotland
7. Emergency and Trauma Centre, The Alfred, Melbourne, Victoria, Australia
8. Intensive Care Unit, The Alfred, Melbourne, Victoria, Australia
9. Australian Centre for Health Innovation, Alfred Health, Melbourne, Victoria, Australia
10. Emergency and Critical Care Medicine, Lin Shin Hospital, Nantun District, Taichung, Taiwan
Background: Resuscitative Endovascular Balloon
Occlusion of the Aorta (REBOA) has recently been
promoted for temporary haemorrhage control as
life-saving intervention in patients with severe, non-
compressible haemorrhage prior to definitive haemorrhage
control.
Aim: To determine if the introduction of REBOA for Aortic
Control of Exsanguinating Trauma Related Haemorrhage
at an adult Australian Adult Major Trauma Centre would
improve survival for major trauma patients until hospital
discharge.
Results: During the study 3,032 patients were admitted
direct from scene through the Alfred Emergency & Trauma
Centre with an overall mortality of 97 (3.71%). Of these
3,019 had trauma centre vital signs recorded and 1,523
were between the ages of 18-60 including 143 with a
Shock Index of >1.0 (4.74%) [indicative of haemorrhagic
shock] - and 13 (0.43%) with a Systolic Blood Pressure
<70 mmHg and/or cardiorespiratory arrest on arrival. The
mortality in this group was 6/13 (46.15%). Of these 13
patients, there were 2 where REBOA was attempted.
There were no eligible patients for whom REBOA was
achieved. Although commenced, REBOA was abandoned
during the resuscitation of the 2 patients. One 80-yo
patient with multisystem trauma, including neurotrauma,
underwent successful REBOA deployment despite
temporarily losing cardiac output during insertion. The
patient died in Intensive Care on day 2 secondary to
severe neurotrauma. None of the other 6 patients who
died would have benefited from REBOA.
Conclusion: Despite considerable training and resource
allocation to ensure 24-hour availability, the introduction
of REBOA failed to demonstrate any impact on patient outcome for this patient cohort.
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AIIMS TRAUMA RECEPTION AND RESUSCITATION© (TRR©) SYSTEM: A PRELIMINARY TRIAL OF THE INTRODUCTION OF TRAUMA RESUSCITATION DECISION SUPPORT TO INDIA
Mark Fitzgerald2, 1, Yesul (Yen) Kim2, Amit Gupta3, Sanjeev K Bhoi3, Ankita Sharma3, Ashish Jhakel3, Gaurav Kaushik3, Joseph Mathew1, Teresa Howard2, Madonna Fahey2, Peter Finnegan2, Mahesh Misra3
1. Trauma Services, The Alfred, Melbourne, Victoria, Australia
2. National Trauma Research Institute, Melbourne, Victoria, Australia
3. JPN Apex Trauma Centre, All India Institute of Medical Science, New Delhi, India
The TRR© system provides the Trauma Team with
computerised decision support for the management of
major trauma, improves protocol compliance and reduces
errors of omission. The primary outcome of this study was to
determine whether the TRR© significantly improves real-time
vital signs data capture and documentation. The secondary
outcome measure evaluated the frequency of Life Saving
Interventions (LSIs) and the time taken to perform them.
The TRR© system was installed into 2 of the 6 resuscitation
area bays within AIIIMS JPN Apex Trauma Center. In the TRR
group, 82 patients were enrolled with 41 non-TRR controls.
Data was extracted automatically from the TRR© system.
Matching control data was entered on-line via a purpose-built
REDCap™ secure web application.
Resuscitation procedures were more accurately recorded,
in real time by staff when TRR© system was in use. There
was a statistically significant difference in the time taken
to insert intercostal catheters between the TRR treatment
group and the controls (p< 0.05). Moreover, the treatment
group exhibited shorter time from arrival to endotracheal
tube (M = 13, SD =0.09), as opposed to 23 minutes (SD
=21.08) for controls (p < 0.005). Importantly, there was a
greater variability in the time taken to perform LSIs in the
control group in comparison to the clinicians assisted with
computerised decision prompts.
The TRR© system was successfully introduced and applied at Level I trauma center in India. With continued use and further data analyses, it shows great potential to be implemented as standard of care for trauma management.
IMPLEMENTING A TRAUMA REGISTRY IN SAUDI ARABIA: A SAUDI TRAUMA REGISTRY (STAR) IS BORNJane E Ford2, 1, Abdulrahman S Alqahtani1, 3, Shatha AA Abuzinada1, Peter A Cameron2, 1, 4, Mark C Fitzgerald5, 6, 7, 8
1. King Saud Medical City, Riyadh, Kingdom of Saudi Arabia
2. Department Epidemiology & Preventive Medicine, Monash University, Melbourne, Victoria, Australia
3. Vision Realization Office, Ministry of Health, Riyadh, Kingdom of Saudi Arabia
4. Emergency & Trauma Centre, Alfred Hospital, Melbourne, Victoria, Australia
5. Alfred Trauma Service, The Alfred, Melbourne, Victoria, Australia
6. National Trauma Research Institute, Melbourne, Victoria, Australia
7. Central Clinical School, Monash University, Melbourne, Victoria, Australia
8. On behalf of the King Saud Medical City - The Alfred International Trauma Program investigators, Melbourne & Riyadh
King Saud Medical City (KSMC) in Riyadh, Kingdom of Saudi
Arabia (KSA) requested collaboration with the Alfred Hospital
and Monash University to establish a Level 1 Trauma
Centre. An essential component of this project is a Trauma
Registry that will collect the data needed to enhance clinical
knowledge and monitor system performance.
Aim: To describe the implementation of the Saudi TraumA
Registry (STAR) and present preliminary findings.
Methods: A 12 step implementation plan was created and
followed at the KSMC. Specifications were written that
enabled KSMC software developers to build a bespoke
database. Operating procedures were provided to guide
daily tasks and enable routine data collection. Regular
reporting was initiated. Data collection commenced on
August 1st 2017.
Results: From the commencement of data collection
to March 30th 2018, 2488 patients that potentially
met inclusion criteria presented to the Emergency
Department at KSMC. Of these, 1056 records have been
entered into the database. Preliminary analysis shows
20.5% were major trauma; mortality of major trauma was
8.8%; 84.7% were male and median age was 28.5 years.
Conclusion: The STAR is now fully operational. In the short
term, process indicators will track the development of
the KSMC into a Level 1 Trauma Centre. In the medium to
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long term the STAR will be deployed nationally to capture
the impact of public health initiatives and socioeconomic
change in the KSA. The effect of the STAR will be that
the country is better equipped to deliver continuous
improvements in trauma systems and quality of care.
ACUTE TRAUMATIC COAGULOPATHY MANAGEMENT IN THE PRE-HOSPITAL SETTING - IT’S ABOUT BLEEDING TIME...
Andrew Hooper1
1. RFDS Western Operations, Jandakot, Western Australia, Australia
Acute Traumatic Coagulopathy (ATC) occurs in severely
injured patients with haemorrhage, is associated with
increased mortality and transfusion requirements, and is
characterised by a fibrinogen deplete state.
Many trauma patients in Western Australia are injured in
remote areas,and require prolonged transfer over vast
distances to reach trauma centres.
Pre-hospital identification of trauma patients with
TIC would enable early replacement of fibrinogen, and
potentially improve outcomes.
However, neither fibrinogen level nor TEG testing is
available in the remote and pre-hospital setting, and
fibrinogen replacement with cryoprecipitate is impractical
in the pre-hospital and transport environment.
Fibrinogen Concentrate (FC) is an alternative product,
widely used in Europe, which is easily stored and
administered to critically bleeding patients.
Can trauma patients with fibrinogen depletion and TIC be
identified in the pre-hospital phase?
A review was performed of all patient transfers by RFDS
WO between 2011 and 2016, to identify trauma patients
who required blood products during flight.
117 patients were identified, and matched with the
transfusion medicine database at Royal Perth Hospital.
The initial fibrinogen level measured following RFDS
transfer was recorded.
This presentation reports the outcomes of this review,
the practicalities of fibrinogen replacement and the
future of haemorrhage management in the pre-hospital
environment.
1. Rossaint R et al. The European guideline on management of major bleeding and coagulopathy following trauma: fourth edition”. Critical Care (2016) 20:100
2. Yamamoto, K et al. Pre-emptive administration of fibrinogen concentrate contributes to improved prognosis in patients with severe trauma. Trauma Surgery & Acute Care Open (2016)1:1-5
3. Davenport and Brohi. Fibrinogen depletion in trauma: early, easy to estimate and central to trauma-induced coagulopathy. Critical Care (2013) 17:190
4. Innerhofer et al. Reversal of trauma-induced coagulopathy using first-line coagulation concentrates or fresh frozen plasma (RETIC): a single-centre, parallel-group, open-label, randomised trial. The Lancet Haematology. Online (2017)
5. Ahmed S et al. The efficacy of fibrinogen concentrate compared with cryoprecipitate in major obstetric haemorrhage—an observational study. Transfusion Medicine (2012) Oct;22(5):344-9.
6. WACHS Guideline for the use of Fibrinogen Concentrate during obstetric haemorrhage at WACHS sites, 2016.
7. Hooper A. Fibrinogen Concentrate – it’s about bleeding time.. ePoster Presentation, ASA and FNA Conference, Sydney, 2017
COMPUTED TOMOGRAPHY (CT) BASED DIAGNOSIS AS AN ALTERNATIVE TO POST MORTEM IN TRAUMA PATIENTS
Vindya Abeysinghe1, Darren Karadimos1, Sudhakar Rao1
1. Health Department of Western Australia, Dalkeith, Western Australia, Australia
Purpose: Post mortem assessment is the current gold
standard investigation to determine cause of death for
trauma patients however the time consuming, costly, and
invasive nature of this technique limits use amongst trauma
patients. Routine computed tomography (CT) assessment
is a highly sensitive technique for identification of injuries
in trauma patients and may represent a non invasive and
cheaper alternative to post mortem examination. We aim to
retrospectively identify the discrepancy in reported injuries
between the two assessments at Royal Perth Hospital
(RPH) State Major Trauma Unit, a level one trauma centre in
Western Australia.
Methodology: All trauma patients who were investigated
by CT scan (head,chest,abdomen) in the emergency
department at Royal Perth Hospital who died whilst in
hospital between 1st January 2008 to 31 December
2017 were identified using the RPH Trauma Registry.
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Patients who underwent post mortem assessment from this group were identified. Demographic data was collected using a standardised data collection form. Comparison between the injuries identified on CT scan and post mortem examination was collected.
Results: Preliminary data is currently being collated.
Conclusion: Post mortem examination is an important tool to determine cause of death. In patients who have undergone CT scans prior, post mortem is unlikely to add further injury towards the cause of death. Implementation of prompt post mortem CT may eliminate the need for
invasive post mortem assessment.
RIB FRACTURE MANAGEMENT IN AN INCREASING ELDERLY POPULATION
James P Laurent1
1. CCDHB, Wellington, New Zealand
Rib fractures are one of the most common injuries related to blunt chest trauma and cause significant problems,
especially in the elderly such as pneumonia and respiratory
failure. The aim of the study was to audit rib fracture
management to review current practice.
Patients admitted to Wellington hospital in the year 2017
with thoracic injuries were reviewed. Demographics,
aetiology, complications and management were recorded.
144 patients were included in the study. Their mean age was
54 years, 35% over 65, and mean ISS of 16. Patients had
a mean of 4 fractured ribs. The main cause of trauma was
related to falls 41%, followed by road traffic collisions 25%
and bicycle accidents 11%. 34% percent were admitted
to cardiothoracic surgery, 18% orthopaedics and 13%
general medicine. Patients admitted under cardiothoracic
surgery had more epidural usage (22% v 6.3%, p = 0.006)
and patient-controlled analgesia (44 % vs 20 %, p<0.001)
compared with other units. More aggressive analgesia was
used with increasing rib fractures. (Epidural 7.47, PCA 3.61,
Oral 2.38, p<0.05). Patients with outcome complications,
namely pneumonia and death, were more likely to be older
with more comorbidities (65 v 51 years, p=0.02). With
45% having comorbidities compared to 11% without
complications (p<0.01).
Older patients with comorbidities are more likely to have a
poorer outcome. This indicates that they will require more
intensive treatment and management to improve outcomes.
This is important as a greater proportion of trauma is
occurring in elderly patients who have a higher mortality.
INTRODUCTION OF PRE-HOSPITAL NOTIFICATION OF INJURED PATIENTS PRESENTING TO TRAUMA CENTRES IN INDIAJoseph Mathew1, 3, 2, Biswadev Mitra1, 4, 3, 5, Gerard O’Reilly1, 4, 5, Teresa Howard1, 2, Mark Fitzgerald1, 3, 2, On behalf of the AITSC Investigator Group
1. National Trauma Research Institute, Prahran, Victoria, Australia
2. Central Clinical School, Monash University, Melbourne, Victoria, Australia
3. Alfred Trauma Service, The Alfred, Melbourne, Victoria, Australia
4. Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
5. Emergency and Trauma Centre, The Alfred, Melbourne, Victoria, Australia
Prehospital notification is the communication by emergency
service personnel to a receiving hospital of the impending
arrival of a patient requiring emergency care. There is currently
no standard system for pre-hospital notification in India.
Aim: To develop and introduce a system for prehospital
notification and patient handover in India.
Methods: An environmental scan of four emergency
departments, three pre-hospital services, and associated
systems and processes was undertaken.
An android app (Suchana) was developed to facilitate the
notification of major trauma cases from the ambulance
to emergency department. Simple patient data is entered
by an emergency medical technician, generating a trauma
triage flag in a corresponding app on duty mobile phone
held by a designated person within the ED. Only “red” major
trauma patients are notified. Once notification is received,
a SuchanaÓ Relay app can then send out a Trauma Team
Activation to notify all other trauma team members for early
preparation and readiness to receive the patient.
Results and Conclusion: Pre-hospital notification using
Suchana commenced in May/June 2017 – Jan/Feb 2018 with
a total of 470 injured patients. The use of Suchana reduced
patient handover time and sped up initiation of treatment
for critical patients. Benefits: improvement in care; proactive
surveillance of patient care and immediate resolution of
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issues; increase in trauma patients being directed to trauma
hospital; trauma team and trauma bay ready; increased
communication with the trauma centre; and improved
completion of patient records.
Ultimately the Indian public ambulance companies are
looking to invest in pre-hospital notification.
THE AUSTRALIAN TRAUMA REGISTRY (ATR) – A NATIONAL VIEW OF SERIOUS TRAUMA
Kate Curtis 1 2 , Mark Fitzgerald 3 4 5 , Jane Ford 3 6 , Emily McKie 3 6 , Teresa Howard 3 4 , Peter Cameron 3 6 7 , On behalf of the Australian Trauma Quality Imporvement (AusTQIP) Collaboration Collaboration
1. Sydney Nursing School, University of Sydney, Sydney, NSW, Australia
2. Critical Care and Trauma, The George Institute for Global Health, Sydney, NSW, Australia
3. National Trauma Research Institute, Prahran, VIC, Australia
4. Central Clinical School, Monash University, Melbourne, Victoria, Australia
5. Alfred Trauma Service, The Alfred, Melbourne, Victoria, Australia
6. Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
7. Emergency and Trauma Centre, The Alfred, Melbourne, Victoria, Australia
Background: Early 2016, the Senate inquiry into Aspects
of road safety in Australia recommended that the
Commonwealth Government commit to funding the
operation of the ATR, supported by the Royal Australasian
College of Surgeons and the Australian Commission on
Safety and Quality in Health. In December 2016, Prime
Minister Malcolm Turnbull announced new funding for
the ATR. Support was provided by the Department of
Infrastructure, Regional Development and Cities and the
Department of Health.
Aim: To characterize serious trauma across 26 major
trauma centres in Australia.
Methods: Collaborators submit 67 data-points in
accordance with the bi-national Trauma Minimum Dataset
for Australia and New Zealand, for severely injured
patients (ISS > 12) or death after injury.
Results: During the 2015/2016 year, data were collected
from 8283 seriously injured patients. Men were over-
represented (72%) except for patients aged ³85 years
where there were more females. Road-related injuries
accounted for 44 percent of cases, while falls accounted
for 33 percent. Two-thirds of patients were transferred
direct from the scene. The median time from scene to
arrival to definitive care was 1.4 hours. The median time
spent in the ED was four hours 13 minutes. The median
length of stay in hospital was 7 days and the median ICU
length of stay was four days. Overall mortality was ten
percent.
Conclusion: Commonwealth support enables the ATR to
provide a national view of serious trauma. Data shows a
wide variation in processes and outcomes, representing
opportunities for improvement.
RENAL TRAUMA: A DECADE IN REVIEW
Munyaradzi G Nyandoro1, Simeon Ngweso2, Mary M Teoh3, Joseph Faraj2, Sana Nasim2, Sudhakar Rao2, Dieter Weber2
1. Acute Surgical Unit & Trauma, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
2. State Major Trauma Unit, Royal Perth Hospital, Perth, Western Australia, Australia
3. School of Medicine, University of Notre Dame, Fremantle, Western Australia, Australia
Introduction: Renal parenchymal injury is an important cause of morbidity in civilian trauma. Management varies between regions and institutions.
Objectives: To understand the epidemiology of traumatic renal injury at the sole major adult trauma unit in Western Australia.
Methods: A retrospective, single-centre review of all patients admitted to the Western Australia Adult State Major Trauma Unit (SMTU) based at Royal Perth Hospital was undertaken from 2005 to 2016.
A comprehensive review of medical and imaging records was completed, capturing key demographics and variables that underpin mechanisms of injuries and management strategies.
Results: 200 patients with traumatic renal injuries were identified – 77.2% (n=153) were male. The mean age was 31 (range 13 - 84). The mean International Severity Score was
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24 (range 9 - 75). 184 patients (92%) sustained blunt force trauma - predominant mechanism was motor vehicle/bike accidents (n=114).
The most frequent grade of injury was Grade 4 with 47.4% (n=94). 47 patients (23.7%) had radiological signs of ureteric or collecting system injury with evidence of urinary extravasation. Surgical or radiological intervention was performed in 32.3% (n=64) of patients. The most common intervention was retrograde ureteric stenting (n=26; 40.6%).
Average length-of-stay in an acute care setting was 14 ± 2 days. Five deaths, not directly attributed to renal trauma, occurred between 0-10 days of admission.
Conclusions: Blunt force trauma accounts for the
majority of renal trauma with non-operative management
successful in the majority of cases. Future studies should
address the effect of current management principles on
long-term outcomes.
A TEN YEAR EXPERIENCE WITH TRAUMATIC RENAL PSEUDOANEURYSM
Munyaradzi G Nyandoro1, Simeon Ngweso2, Mary M Teoh3, Joseph Faraj2, Sana Nasim2, Sudhakar Rao2, Dieter Weber2
1. Acute Surgical Unit & Trauma, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
2. State Major Trauma Unit, Royal Perth Hospital, Perth, Western Australia, Australia
3. School of Medicine, University of Notre Dame, Fremantle, Western Australia, Australia
Introduction: Vascular pseudoaneurysms are a recognised complication following traumatic renal injury (TRI). Pseudoaneurysms in association with non-iatrogenic TRI are rare but an important cause of secondary haemorrhage. Optimum management and follow-up of pseudoaneurysms secondary to TRI is still indeterminate.
Methods: A retrospective, single-centre review of renal trauma patients admitted at the Western Australia Adult State Major Trauma Unit (SMTU) based at Royal Perth Hospital, was undertaken from 2005 to 2016.
A comprehensive review of medical and imaging records was completed to determine the incidence of renal pseudoaneurysm and management strategies. Follow-up CT angiogram was routine for patients with TRIs Grade 3 or higher.
Results: 200 patients were diagnosed with a TRI during the
study period. 4.5% (n=9) patients developed a traumatic
renal pseudoaneurysm, eight occurred following Grade 4
blunt force TRI. None of the eighteen Grade 5 TRIs developed
a pseudoaneurysm, however eight required a nephrectomy.
Eight cases were successfully angio-embolised with only one
repeat procedure. No surgical intervention was required. One
patient was successfully managed conservatively.
Discussion: Traumatic renal pseudoaneurysms are rare with
an incidence rate of 4.5% for the decade in review in this
study. In this centre’s experience, angio-embolisation was
a successful strategy in managing these lesions. Further
prospective research is necessary to determine optimum
management and follow-up strategies for traumatic renal
pseudoaneurysms.
EVALUATING THE SEVERITY OF PAEDIATRIC AUSTRALIAN RULES FOOTBALL INJURY
Cameron Palmer1, 2, Leopold Simma1, 3, Helen E Jowett1, Warwick J Teague1, 4, 5
1. Royal Children’s Hospital Melbourne, Parkville, Victoria, Australia
2. Dept Epidemiology & Preventive Medicine, Monash University, Melbourne, Victoria, Australia
3. Emergency Department, Children’s Hospital Lucerne, Lucerne, Switzerland
4. University of Melbourne, Melbourne, Victoria, Australia
5. Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
In many states, Australian Rules football (known
eponymously as AFL) outranks all other sports in terms
of ED presentations and hospital admissions; injury rates
may be higher for AFL than any other code. However, no
recent epidemiology has been published, and the overall
profile of severe injury is unknown.
This study aimed to evaluate patterns in hospital-treated
AFL-related injuries at a large paediatric hospital, and to
compare the hospital-related burden of injury to that of
other team ball sports (TBS) using ED presentation and
Trauma Registry data over seven years
521,790 ED presentations, including 100,075 injury
presentations were reviewed. 10,003 presentations were
TBS-related, including 4,751 AFL-related presentations. A
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total of 1,110 TBS patients were subsequently admitted including 616 AFL patients
The incidence of AFL injury increased with age; AFL accounted
for one in seven trauma-related ED presentations amongst
14-15 year olds, and 13% of injury admissions.
Patients presenting to ED after AFL injury were twice as
likely to sustain multiple injuries as other TBS patients, and
significantly more likely to be classified as severely injured.
Patients admitted after AFL injury were less likely to sustain
fractures, but significantly more likely to sustain injuries to
the head, neck, chest or abdomen. Numerically, AFL patients
required substantially more bed days than other TBS patients
despite similar patient numbers.
AFL is a common cause of ED presentations and results in
substantial morbidity. Previously suggested strategies for
reducing injury risk such as helmets and rule modifications
for younger players should continue to be encouraged.
CRITICAL INCIDENTS AND TRAUMA DEATHS - IT’S ABOUT PERSPECTIVES
George Perrett1, Ryan Looney2, Katrina Coppin3, Michael Parr1
1. ICU, Liverpool, Sydney, New South Wales, Australia
2. Trauma, Liverpool, Sydney, New South Wales, Australia
3. Clinical excellence committee, Sydney, New South Wales, Australia
Analysis of critical incidents is crucial for quality
improvement. The themes of critical incidents occurring in
trauma patients, who subsequently died, at a designated
Trauma Centre in Sydney were compared to themes
associated with trauma deaths reported to the state-wide
Incident Information Management System Root Cause
Analysis (RCA) process.
Liverpool Hospital has an established rigorous multi-
disciplinary trauma mortality peer review process to
identify errors and classify deaths. Deaths are classified
as ‘potentially, probably or definitely avoidable’ or ‘non-
avoidable’. None met regional RCA referral criteria.
The CEC has a multi-disciplinary peer review committee
that reviews all RCAs and identifies principal incident
type, risk groups, interest groups, human factors, patient
factors, system factors, and recommendation categories.
During 2015/16 69 trauma deaths, with 282 incidents,
spread across 59 cases occurred at Liverpool. 6 deaths
were rated as potentially avoidable with 56 associated
incidents, of which 15 were considered major impact.
During 2016/2017 21 trauma related state-wide RCAs. 5
classified as inadequate treatment, 3 wrong treatment,
3 missed diagnosis, 2 not recognising significance of
observations but only 2 relating to delay or non-timeliness
of care.
The main theme for major impact incidents at Liverpool
was ‘delays in treatment and diagnosis’ (10). Other
categories included ‘errors in judgement or diagnosis’ (3)
and ‘complications as a result of treatment’ (2).
Examples of delays included getting CT imaging, getting
to the operating theatre, reversing coagulopathy and
reinitiating usual medications.
The different review systems demonstrate different
issues that may impact trauma deaths and provide
potential for prevention.
CARDIAC CONTUSIONS: A COMPARISON OF NUCLEAR MEDICINE IMAGING AND TRANSTHORACIC ECHOCARDIOGRAPHY IN BLUNT TRAUMA
Adam Philipoff1, Dieter Weber1, Sudhakar Rao1
1. Trauma Surgery, Royal Perth Hospital, Perth, Western Australia, Australia
Purpose: The role of nuclear medicine studies in the
evaluation of cardiac contusions (CC) remains unclear.
Most studies examining myocardial perfusion scans (MPS)
are relatively old (1980’s). Management guidelines for the
screening of blunt cardiac injury recommend the selective
use of transthoracic echocardiography (TTE). However,
MPS may be clinically relevant in detecting CCs. This
retrospective case series compares two different imaging
modalities, TTE and MPS, in patients diagnosed with CC.
Methods: All patients diagnosed with CC (positive cardiac
troponin and blunt thoracic trauma) between 2008-2013 were identified from the trauma registry. Only patients who underwent both a TTE and MPS during their index admission were analysed. Data including demographics, injury characteristics, troponin studies and imaging results were obtained.
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Results: 71 patients were included. 23 patients had
imaging evidence (MPS and/or TTE) of CC. The sensitivity of MPS and TTE were 31% (22/71) and 11.3% (11/71), respectively. Troponin levels were significantly higher in patients diagnosed with CC on imaging. Admission troponin level (mean) for the contusion and non-contusion group were 2.32ug/L and 0.49ug/L respectively, p-value 0.022. An admission Troponin threshold value >0.75ug/L was the point at which CCs were more likely to be identified on imaging, p-value 0.027. TTE Image quality was generally poor or limited (46/71).
Conclusions: MPS is more sensitive than TTE in detecting CCs in blunt trauma patients that have an elevated
troponin level. Troponin levels strongly correlate with
imaging evidence of CCs. MPS is complimentary to TTE for
ruling out CCs and impacts patient follow up pathways.
MANAGEMENT INTERVENTION SIGNIFICANTLY IMPROVES TRAUMA OUTCOMES AT ONE OF THE BUSIEST EMERGENCY DEPARTMENT IN PERTH.
Glynis Porter1
1. Joondalup Health Campus /Ramsay Health Care, Joondalup, Western Australia, Australia
Joondalup Health Campus (JHC) is a 716 bed private/
public non tertiary hospital operated by Ramsay health
care located 20km north of Perth CBD, treating adult
and paediatric patients in the rapidly growing northern
suburbs of Perth. The Emergency department has 57 beds including 3 resuscitation beds. There were 69,238 ED Presentations in 2010 and 98,549 in 2017. JHC was designated a Level 4 trauma facility (Level 3 NRTAC) which includes 24hr surgical, anaesthetics and ICU cover.
JHC Trauma Registry (JHCTR) commenced in January 2010 to capture accurate data for major and minor trauma. We identified a need to improve our hospital trauma call system and introduced a 2 tier system (ED and Hospital) in 2011. During 2010-2017 12,353 patients were recorded in the JHCTR with 299 major trauma transferred to tertiary facilities.
State trauma introduced a Tertiary Trauma Survey form
in 2014. This was implemented to accurately document
a tertiary trauma survey on all trauma patients ensuring a
full systemic assessment prior to discharge.
The systems introduced have been monitored by the
trauma registry with improvements recorded in all areas
including the following four key performance indicators
adopted by the State Trauma Registries:
• Direct admission to ED Resuscitation Room
• Trauma team activation
• Tracheal intubation
• Time to CT scan
Management of all trauma patients has significantly
improved especially stabilisation of major trauma
patients prior to transferring to the tertiary hospital and
major trauma centres.
FINGER THORACOSTOMY IN CHILDREN: AN OVERVIEW OF THE PAEDIATRIC EXPERIENCE IN TRAUMA IN VICTORIA
Nuala Quinn1, 2, Cameron Palmer3, 2, Helen Jowett2, Warwick Teague4, 5, 6, 2
1. Murdoch Children’s Research Institute, RCH, Melbourne, Victoria, Australia
2. Trauma Service, Royal Children’s Hospital, Melbourne, Victoria, Australia
3. Epidemiology & Preventive Medicine, Monash University, Melbourne, Victoria, Australia
4. Paediatric Surgery, RCH, Parkville, Victoria, Australia
5. Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
6. Surgical Research Group, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
Introduction: Tension pneumothorax as a result of
chest trauma may be a rapidly life-threatening event.
Immediate management is lifesaving. Traditionally
needle thoracostomy was performed, however it has
been shown to be an unreliable method of pleural
decompression. Finger thoracostomy has been
introduced as procedure at RCH in 2017 and by the
Victorian ambulance services in 2016.
Aim: To describe the state experience of finger
thoracostomy in paediatric trauma patients in Victoria.
Methods: Patient records since 2016 were reviewed to
identify instances of finger thoracostomy performed by
Ambulance Victoria prior to RCH arrival, and within RCH.
Patient records were then gleaned and data obtained
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pertaining to: mechanism of injury, indication for
thoracostomy, procedures performed and complications
which occurred as a result of thoracostomy or intercostal
catheter insertion.
Results: Seven patients were identified: 4 prior to RCH
arrival, 2 performed in the ED at RCH and one patient
had a thoracostomy performed in both settings. 6
patients had bilateral thoracostomies performed. The
mechanism was a motor vehicle accident in 3 of the
patients, bike versus car in two. A quadbike and tractor
rollover were the remaining mechanisms. One patient was
pronounced dead in ED. All the remaining patients were
admitted to PICU and had serious associated injuries;the
most common being intracranial haemorrhages, intra-
abdominal lacerations and rib fractures.
Conclusion: This is a descriptive study of Finger
Thoracostomy in paediatric patients at a large tertiary
trauma centre. It includes those done pre-hospital. Finger
thoracostomy is a lifesaving procedure. Associated
injuries are very serious and the patients have long
inpatient stays.
LIVE PATIENT SIMULATION: AN EXCITING TOOL IN TRAUMA EDUCATION
Tom Ryan1, Andrew Challen1, Andrew Lamb11, Matthew Harper1, Jim Cooper1
1. Fiona Stanley Hospital, Murdoch, Western Australia, Australia
Introduction: Simulation is a common tool for health
professional education, particularly in critical care. We
aimed to utilise a live patient to enhance realism and
participant engagement during a trauma simulation.
Methods: Planning- A session in the scheduled
emergency department multidisciplinary in-situ
simulation timetable was identified. Participation was
confirmed with the live patient actor, facilitators and
relevant hospital departments. Participants received
a pre-briefing covering guidelines for the simulation
including safety.
Simulation- An unstable penetrating trauma scenario was
created; with participants expected to identify the need
for damage control surgery and facilitate a rapid transfer
from the emergency department to the operating theatre.
Simulation parameters were chosen to avoid ambiguity
in the clinical picture. Extensive moulage was utilised to
enhance realism and all actions were completed in real time
using actual hospital systems and equipment.
Debrief-The simulation concluded with separate debriefs for
the emergency department and theatre. This was to ensure
relevant feedback and also to facilitate a timely return to
clinical duties.
Results: Over 30 medical, nursing and technical staff
from three departments were involved in the scenario.
The patient arrived in theatre within 20 minutes of
presentation to the emergency department, with
the realism of the scenario praised by participants.
Themes explored during the debrief included leadership,
communication and patient flow.
Conclusions: The use of a live patient represents a powerful
tool to engage clinical staff in simulation activities. Our
scenario generated useful feedback to improve skills and
processes at an individual, department and hospital level.
EXTERNAL BENCHMARKING OF TRAUMA SERVICES IN NEW SOUTH WALES: RISK-ADJUSTED MORTALITY AFTER MODERATE TO SEVERE INJURY FROM 2012 - 2016
David Gomez, Pooria Sarrami, Hardeep Singh, Zsolt Balogh, Michael Dinh, Jeremy Hsu
Objective: To generate risk-adjusted mortality for the
purpose of external benchmarking of trauma services in
New South Wales (NSW).
Design: Retrospective cohort study using data from the
NSW Trauma Registry. We focused on adults (>16 years),
with an Injury Severity Score >12, that received definitive
care at either Major Trauma Services (MTS) or Regional
Trauma Services (RTS) between 2012-2016.
Main outcome measure: In-hospital death.
Methods: Given the nested structure of the data,
hierarchical logistic regression models were used to
generate risk-adjusted outcomes. Demographic, vital
sign, and injury characteristics were included as fixed
effects. Median Odds Ratios (MOR) and centre-specific
Odds Ratios of death with 95% confidence intervals
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were generated. Centre-level variables were then
explored as sources of variability in outcomes.
Results: We identified 14,452 patients whom received
definitive care at one of seven MTS (n=12,547) or one
of ten RTS (n=1,905). Unadjusted in-hospital death was
lower at MTS (9.4%) compared to RTS (11.2%). The
MOR was 1.33, suggesting that the odds of in-hospital
death was 1.33-fold greater if a patient was admitted to
a worse performing as opposed to a better performing
centre. Definitive care at MTS was associated with a
41% lower likelihood of death (OR 0.59 95%CI 0.35-
0.97) compared to RTS.
Conclusion: Risk-adjusted outcomes favoured MTS;
however, there was moderate between-centre variability.
Best practices should be identified and disseminated
throughout the system. The ongoing evaluation of
system performance, as well as targeted interventions
derived from such analyses, are instrumental in the
delivery of high-quality care for injured patients.
MOTORCYCLE CRASH TRAUMA ADMISSIONS IN THE MIDLAND REGION OF NEW ZEALAND: WHAT THE POLICE DON’T SEE.
Alastair Smith1, Alicia Ferrer Costa2, John Garvitch3, Kaye Clark4, Grant Christey5, 6
1. Midland Trauma Research Centre, Waikato District Health Board, Hamilton, Waikato, New Zealand
2. Public Health Unit, Waikato District Health Board, Hamilton, Waikato, New Zealand
3. System Performance, New Zealand Transport Agency, Hamilton, Waikato, New Zealand
4. Safety & Environment, New Zealand Transport Agency, Hamilton, Waikato, New Zealand
5. Midland Trauma System, Waikato District Health Board, Hamilton, Waikato, New Zealand
6. U. Auckland Medical School, University of Auckland, Hamilton, Waikato, New Zealand
During 2012-2016, the New Zealand Transport Agency
(NZTA) ‘Crash Analysis System’ (CAS) recorded a total of
1,331 motorcycle crashes occurring on roads within the
Midland Region of New Zealand as collected by NZ Police.
During the same period, the Midland Trauma System (MTS)
trauma registry (located at Waikato Hospital) recorded
694 persons being admitted to hospital due to on-road
motorcycle crashes within the same geographical area.
Merging of the two datasets has revealed an under-
reporting of motorcycle crashes among police derived
recording by 19%. Furthermore, only 54% of hospital
admitted motorcycle crash casualties were captured
among police motorcycle crash records. A range of
factors appear to underlie this mismatch including high
rates of self-presentation to hospital among trauma
registry-only patients (non-CAS-matched), low reporting
of pillion passenger casualties among police records,
and geographic location of point of injury. Mapping of
point of injury further suggests that those patients who
were not among police records tended to be more rural in
nature. Where CAS-Police and hospital admitted records
were matched, concordance between crash severity,
recorded by police, and hospital admission rates, and injury
severity (ISS – Injury Severity Score) highlighted further
mismatch. Significant numbers of casualties from crashes
recorded as minor by police still resulted in hospital
admission including Major (ISS>12) trauma admissions.
By merging these two datasets, a rich new source of
insight surrounding motorcycle crashes, their fuller extent,
circumstances, and nature of injuries has been created.
VALIDATION OF TWO PHYSICAL ACTIVITY AND SEDENTARY BEHAVIOUR QUESTIONNAIRES IN ORTHOPAEDIC TRAUMA PATIENTS
William G Veitch1, Rachel E.D Climie2, Belinda J Gabbe1, David W Dunstan2, Neville Owen2, Christina L Ekegren1, 2
1. Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
2. Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
Introduction: Orthopaedic trauma can be a catalyst for
substantially reduced physical activity and increased
sedentary behaviour that can persist post-recovery.
While objective measures provide rigorous approaches
to assessing physical activity and sedentary behaviour,
valid self-report measures provide potential alternatives
in some patient groups. The aim of this study was
to determine, in orthopaedic trauma patients, the
agreement and concordance of physical activity
and sedentary behaviour data from the International
Physical Activity Questionnaire (IPAQ) and the Australian
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Diabetes, Obesity and Lifestyle General Questionnaire 3
(AusDiab3), with data derived from objective measures.
Methods: 64 patients with isolated upper- or lower-
limb fractures wore two activity monitors (ActiGraph,
ActivPAL) for 10 days, from 2-weeks post-surgery.
Participants then completed the IPAQ and AusDiab3
questionnaires relating to the previous 7 days of
monitoring. Bland-Altman plots, Lin’s Concordance
Correlation Coefficients (LCCCs) and weighted kappa
statistics were used to assess agreement and
concordance across several variables.
Results: The IPAQ overestimated objectively–assessed
overall physical activity (median METmins: 550 vs.0) and
underestimated median daily sitting time (8.00 vs.10.59
hrs). The AusDiab3 questionnaire underestimated
median daily sitting time to a lesser degree than the
IPAQ (9.21 vs.10.53hr/day). There was moderate
concordance between IPAQ-reported and objectively-
derived overall physical activity (p=0.431, p<0.001), and
moderate concordance between AusDiab3-reported and
objectively measured sitting time (p=0.551, p<0.001).
Conclusion: There was disagreement and discordance
between the IPAQ and Ausdiab3 questionnaire and
objectively-derived data, suggesting that these
measures cannot be used interchangeably in orthopaedic
trauma patients without appropriate modifications.
EVALUATION OF THE MAJOR TRAUMA RECOVERY COORDINATOR ROLE: EARLY FINDINGS
William Veitch1, Sara Calthorpe2, Lara Kimmel1, 2, Mark Fitzgerald3, 4, 5, 6, Sandra Braaf1, Belinda Gabbe1, 7
1. Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
2. Department of Physiotherapy, The Alfred, Melbourne, Victoria, Australia
3. National Trauma Research Institute, The Alfred, Melbourne, Victoria, Australia
4. Emergency and Trauma Centre, The Alfred, Melbourne, Victoria, Australia
5. Trauma Service, The Alfred, Melbourne, Victoria, Australia
6. Central Clinical School, Monash University, Melbourne, Victoria, Australia
7. Farr Institute, Swansea University Medical School, Swansea University, Swansea, United Kingdom
Background: Previous research involving Victorian trauma
services has highlighted issues with discharge planning,
coordination of post-discharge care, and the quality of
information provided to patients about their care and
outcomes. The Major Trauma Recovery Coordinator (MTReC)
role was designed to provide a single point of contact for
major trauma patients to overcome the identified issues.
A 2-year pilot project was established to evaluate the
MTReCs. The aim of this analysis was to provide an overview
of MTReC engagement in the first 8 months.
Methods: Linkage of the purpose-built MTReC REDCap
database with the Victorian State Trauma Registry
(VSTR) was undertaken to compare the engagement rate
between MTReCs and major trauma patients admitted
through the trauma service.
Results: From February to September 2017 (inclusive),
956 major trauma patients were managed at The
Alfred and 304 were coordinated by the MTReCs.
MTReC patients were more commonly road trauma
and compensable patients, had a higher Injury Severity
Score, longer length of stay, and lower socioeconomic
status. A higher proportion were also discharged to
rehabilitation. There was a significant improvement in
the rate of MTReC engagement over time, and a shift
towards coordination of cases more representative of
the wider major trauma population. Further data from the
evaluation will be available for presentation.
Conclusions: This preliminary analysis summarises
the pattern of engagement of the MTReCs with major
trauma patients, the early bias in engagement with more
severely injured patients and the changing focus of the
MTReCs over time as the role became more established.
WORK-RELATED TRAUMATIC INJURY IN AUSTRALIAN TRUCK DRIVERS
Ting Xia1, Ross Iles1, Alex Collie1
1. Insurance Work and Health Group, Faculty of Medicine Nursing and Health Sciences, Monash University, St Kilda, Victoria, Australia
Objectives: The trucking industry is one of the highest
risk industries for work-related injury and disease in
Australia. The objective of this study was to compare the rate and distribution of work-related traumatic injury in truck drivers and other workers in Australia.
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Method: All accepted workers’ compensation claims
from 2004 to 2015 were extracted from the National
Dataset for Compensation-based Statistics. We used
standardized industry and occupation coding systems to
identify truck drivers and other occupational groups, and
the Type of Occurrence Classification System (TOOCS) to
identify work-related traumatic injury.
Results: Traumatic injuries were the second most
common condition in truck drivers’ (24% of total), after
musculoskeletal conditions. However, traumatic injury
due to vehicle incidents was the most common cause of
work-related fatality claims in truck drivers, accounting
for over 70% of all fatality claims. Truck drivers also
recorded an elevated rate of traumatic injury, at 16.6
claims per 1000 workers per year which was 66% higher
than bus, delivery and automobile drivers. The incidence
rate of traumatic fatality claims in truck drivers was 15
times higher (23.7 per 100,000 workers) than all other
workers (1.6 per 100,000 workers). In addition, traumatic
injury resulted in 15,315 weeks (12.9%) of working time
loss per year, on average.
Conclusion: Truck drivers are at significantly higher
risk of traumatic injury than other workers. Our findings
support the continued focus on occupational health and
safety and road safety research to reduce the number of
traumatic injuries in truck drivers.
A RETROSPECTIVE ANALYSIS OF THE UTILITY OF CERVICAL SPINE MRI IN PATIENTS WITH NORMAL CT AND PLAIN RADIOGRAPHS
Adeline Yap1, Sana Nasim1, Sudhakar Rao1, Swithin Song2
1. Trauma, Royal Perth Hospital, Perth, Western Australia, Australia
2. Radiology, Royal Perth Hospital, Perth, Western Australia, Australia
Introduction: Following acute blunt cervical injury, there
is ongoing debate regarding the reliability of Computed
Tomography (CT) and plain radiographs versus the need
for Magnetic Resonance Imaging (MRI).1
Objectives: To determine the incidence of abnormalities
found on MRI following normal CT or plain radiographs
in patients with persistent cervical tenderness, focal
neurology or are clinically unevaluable and to assess if
management was altered following MRI.
Results: 301 patients were included in this single-centre
retrospective analysis. 155 (51.5%) had no acute
injury found on MRI. Of the remaining 146 abnormal MRI
scans, there were 107 with ligamentous injury, 44 with
vertebral disc injury, 34 with soft tissue swelling, 13
with microtrabecular fracture, 9 with dural haematoma, 5
with cervical cord injury and 3 with joint effusion (some
patients sustained >1 type of injury). Post-MRI, 67.1%
were spinally cleared, 29% conservatively managed
eg brace, soft collar, mobilise as tolerated or bedrest,
whereas 1.3% underwent surgical management.
Discussion: There was a statistically significant
correlation between having a positive MRI result and
the likelihood of receiving some form of treatment,
highlighting that MRI not only has the ability to alter
management but also reduce the risk of long-term
morbidity secondary to missed injuries. However, no
correlation was found between the type of injury on MRI
with the type of management a patient received.
Conclusion: In patients with acute blunt cervical injury,
MRI is useful for detecting injuries that would have
been missed on CT or plain radiographs and would have
otherwise altered management.
1. 1. A Maung, D Johnson, K Barre, T Peponis, T Mesar, G Velmahos, et al; Cervical spine MRI in patients with negative CT: a prospective, multicentre study of the Research Consortium of New England Centers for Trauma (ReCONECT). J Trauma Acute Care Surg. 2016; 82(2): 263-9.
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What is the ATS?
The ATS is Australasia’s only multidisciplinary
trauma society. The society was established in
1994 and currently has several hundred members.
What does the ATS do?
Trauma across the spectrum is represented by
many clinicians who individually are members of
their particular specialty groups and colleges. As
members of the ATS the area of multidisciplinary
trauma management is the focus.
Benefits of Membership
Quarterly Trauma Talk e-newsletter with
contributions from the ATS Committee
and Members
Three hard copy issues of the Journal
Injury and access to another 9 copies per
year electronically (value $300/year)
Opportunity to serve on the National
Executive and influence trauma care in
Australia and New Zealand
Involvement in special interest groups
Discounted r egistration fees at ATS
conferences
Please complete the form opposite
and fax to the ATS Secretariat:
+61 2 9431 8677.
To find out more about becoming a member
please call +61 2 9431 8668
or email ats@theassociationspecialists.com.au
www.traumasociety.com.au
ATS Secretariat, PO Box 576, Crows Nest NSW Australia 1585
Tel: +61 2 9431 8668 Email: ats@theassociationspecialists.com.au
Australian Trauma Society
Membership Application Form
FAX: +61 2 9431 8677
E MA IL: ats@theassociationspecialists.com.au
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What is the ATS?
The ATS is Australasia’s only multidisciplinary
trauma society. The society was established in
1994 and currently has several hundred members.
What does the ATS do?
Trauma across the spectrum is represented by
many clinicians who individually are members of
their particular specialty groups and colleges. As
members of the ATS the area of multidisciplinary
trauma management is the focus.
Benefits of Membership
Quarterly Trauma Talk e-newsletter with
contributions from the ATS Committee
and Members
Three hard copy issues of the Journal
Injury and access to another 9 copies per
year electronically (value $300/year)
Opportunity to serve on the National
Executive and influence trauma care in
Australia and New Zealand
Involvement in special interest groups
Discounted r egistration fees at ATS
conferences
Please complete the form opposite
and fax to the ATS Secretariat:
+61 2 9431 8677.
To find out more about becoming a member
please call +61 2 9431 8668
or email ats@theassociationspecialists.com.au
www.traumasociety.com.au
ATS Secretariat, PO Box 576, Crows Nest NSW Australia 1585
Tel: +61 2 9431 8668 Email: ats@theassociationspecialists.com.au
Australian Trauma Society
Membership Application Form
FAX: +61 2 9431 8677
E MA IL: ats@theassociationspecialists.com.au
Name:
Position:
Organisation:
Address:
City: State:
Postcode: Country:
Tel: Fax:
Email:
Membership Type (please tick):
Ordinary Member $198.00 (incl. GST)
Associate Member $132.00 (incl. GST)
Category (please tick):
Doctor Allied Health Nurse Paramedic Other
Payment Options:
Visa MasterCard
Card Number:
Name on Card:
Expiry Date:
Signature:
Date:
A joining fee of $22 (incl. GST) will be applied to all new memberships
$209.00
$140.00
5TH WORLD TRAUMA CONGRESS26TH - 29TH OCTOBER 2020
BRISBANE CONVENTION & EXHIBITION CENTRE
QUEENSLAND, AUSTRALIA
For further information please contact:
World Trauma CoalitionWorld Trauma 2020 Conference SecretariatPO Box 576Crows Nest NSW Australia 1585P: +61 2 9431 8600E: wtc2020@theassociationspecialists.com.au
www.worldtrauma2020.com
HOSTED BY:
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T R A U M A 2 0 1 8 C O N F E R E N C E P R O G R A M A N D A B S T R A C T B O O K
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3-6 October 2019 | Sofitel Sydney Wentworth, NSW, Australia
TRAUMA 2019Collaboration, innovation and the way forward
traumaconference.com.au