CELL SYSTEM INTEGRATION (CSI) TRAUMA
Trauma and injury pose a significant medical, social and financial challenge to Australian and New Zealand health-care systems. There are almost 500 000 admissions to hospitals annually with more than 5000 seriously injured patients. Trauma systems have received increased attention with worldwide disasters and terrorism. While lessons have been learnt, the key to optimal disaster response is a functioning trauma system. Do we seriously believe that we have achieved this?
Understanding the aetiology of trauma and its outcomes has been aided by the expansion from institutional trauma registries to not only state-based registries but now a bi-national registry for seriously injured patients in Australia and New Zealand.1
It is becoming increasingly clear that one of the greatest opportunities to improve delivery of trauma care lies in medical decision-making and judgement in the early phases of trauma care. The early clinical involvement of senior personnel in the Emergency Departments of our trauma receiving hospitals is essential. Fitzgerald and colleagues recognize this and are to be admired for looking at new research strategies for trying to enhance the initial hospital response to trauma.2
A national task force in both countries is now required to consolidate consistent trauma care. This must include Indigenous communities. Jacob et al. have provided us with a startling insight into penetrating trauma in the Aboriginal communities of Central Australia. The incidence of stabbing of 390/100 000 is one of the highest in the world and must be met with a concerted effort of prevention. It is a national disgrace.3
Training our surgeons of the future has been a focus of much college activity of the last few years. Trauma training appears to pose a very unique challenge. Hamill in a study of paediatric surgeons and trainees found, that although 82% had undertaken Early Management of Severe Trauma (EMST), only 22% had completed the Definitive Trauma Surgical Care Course.4 In addition, in the group surveyed, exposure to trauma was problematic with each surgeon only carrying out between one and five laparotomies per year. Concentration of trauma cases to reduced numbers of trauma centres is a logical step. This has been successfully achieved in some States, but remains a problem particularly in New South Wales (NSW). Recently 13 of 14 trauma directors in NSW rejected the Health Department’s plan to maintain a large number of trauma centres, a plan, in effect, denying patients experienced trauma surgeons.
Trauma is a rapidly changing with increasing non-operative management and Thompson and Holland have shown this in their review of patients admitted to the Children’s Hospital, Westmead.5 Angioembolization in important adult trauma centres has changed clinical care even further. Familiarity with patterns of disease are essential to improve outcomes and Risgaard et al. while dealing with a small group of patient in their review of blunt cerebrovascular injury expose the high stroke and mortality rates. This can be altered with early detection of cerebral vascular injury through properly sequenced (consultant read) four-vessel Angio CT. Clinical practice guidelines, such as those on for anterior abdominal stab wounds, have stimulated not only discussion, but also enhanced knowledge. Practice guidelines, while commendable, need to be implemented and tested in staff treating trauma patients. Performance testing of key trauma emergency staff should be compulsory in Australia and New Zealand.6
Fellows of the College have been strong supporters of trauma, and trauma surgeons, perhaps, in part, due to sympathy for the challenges of their day-to-day work and interaction with hospital administration and the Health Department viewed to be in touch with front-line trauma care.
To enhance trauma special support, packages are required for training, trauma surgeons and national approaches in both the countries. The cells of injured trauma patients will not survive without a system that is integrated for trauma care (CSI Trauma).
