Timing of tertiary trauma surveys during a time of increased trauma presentations - The Alice Springs Hospital Finke Desert Race experience.

Purpose: The Finke Desert Race is an offroad motorbike and buggy race held annually in central Australia. Owing to the treacherous conditions, this race sees a significant influx of trauma presentations to Alice Springs Hospital, the closest rural hospital. Completion of a tertiary trauma survey (TTS) within 24 hours of a patient's admission is part of standard trauma management. Method: A retrospective analysis was undertaken of trauma presentations managed by general surgery over a 5-day period of the Finke Desert Race weekend, compared to a 3-month control period from February to April of the same year. To be included, patients met the criteria for completion of a TTS. Results: The total number of trauma presentations over the 5-day period of the race weekend was 18 (an incidence rate of 3.6 cases/day), compared to a total of 31 in the 3-month control period (an incidence rate of 0.36 cases/day). The daily rate of major trauma presentations during the Finke race weekend was 9.9 times greater than during the control period. Completion of TTS was missed in only 5.6 % of patients over the Finke weekend, compared to 14.3 % of patients in the control period. The median time from presentation to the emergency department to completion of TTS during the Finke weekend was 20 h 19 min, compared to 20 h 36 min during the control period. Conclusion: Despite the substantial influx of trauma during the race weekend, fewer patients missed having a TTS completed compared to the control period. The median time taken to completion of TTS was similar between the two time periods. These findings suggest that the general surgery department was able to maintain standard trauma management principles.

Idiopathic ascites following laparoscopic appendicectomy: a case report.

Appendicitis is a common condition and is frequently treated with a laparoscopic appendicectomy. We present a rare case of delayed, idiopathic ascites following laparoscopic appendicectomy for histologically confirmed appendicitis. While the complications of this condition and this procedure are well documented, this case demonstrates very rare sequelae following a laparoscopic appendicectomy.

A case of endovascular management to gain control of a lower gastrointestinal haemorrhage caused by appendiceal artery bleeding.

Bleeding from the appendix is a rare cause of lower gastrointestinal haemorrhage. Previous publications have noted diagnosis via colonoscopy or computed tomography angiogram and treatment via surgical or endoscopy. We report a case of large volume per rectal bleeding from the appendix, with diagnosis and treatment via angiography and coil insertion, which is the first of its kind reported in the literature.

Comparison of Operative Logbook Experience of Australian General Surgical Trainees With Surgeons Deployed on Humanitarian Missions: What Can Be Learnt for the Future?

OBJECTIVE: General surgical training in Australia has undergone considerable change in recent years with less exposure to other areas of surgery. General surgeons from many high-income countries have played important roles in assisting with the provision of surgical care in low- and middle-income countries during sudden-onset disasters (SODs) as part of emergency medical teams (EMTs). It is not known if contemporary Australian general surgeons are receiving the broad surgical training required for work in EMTs. DESIGN: Logbook data on the surgical procedures performed by Australian general surgical trainees were obtained from General Surgeons Australia (GSA) for the time period February 2008 to February 2017. Surgical procedures performed by Médecins sans Frontières (MSF) surgeons during 5 projects in 3 SODs (the 2010 Haiti earthquake, the 2013 Philippines typhoon and the 2015 Nepal earthquake) were obtained from previously published data for 6 months following each disaster. SETTING AND PARTICIPANTS: This was carried out at the University of Sydney with input from MSF Operational Centre Brussels and GSA. RESULTS: Australian general surgical trainees performed a mean of 2107 surgical procedures (excluding endoscopy) during their training (10 6-month rotations). Common procedures included abdominal wall hernia repairs (268, 12.7%), cholecystectomies (247, 11.8%), and specialist colorectal procedures (242, 11.5%). MSF surgeons performed a total of 3542 surgical procedures across the 5 projects analyzed. Common procedures included Caesarean sections (443, 12.5%), wound debridement (1115, 31.5%), and other trauma-related procedures (472, 13.3%). CONCLUSIONS: Australian general surgical trainees receive exposure to both essential and advanced general surgery but lack exposure to specialty procedures including the obstetric and orthopedic procedures commonly performed by MSF surgeons after SODs. Further training in these areas would likely be beneficial for general surgeons prior to deployment with an EMT.

Australasian general surgical training and emergency medical teams: a review.

Emergency medical teams (EMTs) have provided surgical care in sudden-onset disasters in low- and middle-income countries. General surgeons have been heavily involved in many EMTs due to their traditional broad set of surgical skills and experience. With the increased subspecialization of general surgical training in many high-income countries, including Australia and New Zealand, finding general surgeons with adequately broad experience is becoming more challenging. Furthermore, it is now considered standard for EMTs deploying to a sudden-onset disaster to have undergone credentialing, demonstrating sufficient training of their deployed members. The purpose of this review was to highlight the challenges and potential solutions facing those involved in training and recruiting general surgeons for EMTs in Australasia.

Surgical Procedures Performed by Emergency Medical Teams in Sudden-Onset Disasters: A Systematic Review.

BACKGROUND: Emergency medical teams (EMTs) frequently provide surgical care after sudden-onset disasters (SODs) in low- and middle-income countries. The purpose of this review is to describe the types of surgical procedures performed by EMTs with general surgical capability in order to aid the recruitment and training of surgeons for these teams. METHODS: A search of electronic databases (PubMed, MEDLINE, and EMBASE) was carried out to identify articles published between 1990 and 2018 that describe the type of surgical procedures performed by EMTs in the impact and post-impact phases of a SOD. Further relevant articles were obtained by hand searching reference lists. RESULTS: A total of 16 articles met the inclusion criteria. Articles reporting on EMTs from a number of different countries and responding to a variety of SODs were included. There was a high prevalence of procedures for extremity soft tissue injuries (46.8%) and fractures (28.3%), although a number of abdominal and genitourinary/obstetric procedures were also reported. CONCLUSIONS: Based upon this review, deployment of surgeons or teams with experience in the management of soft tissue wounds, orthopaedic trauma, abdominal surgery, and obstetrics is recommended.

Rapid response team calls to patients with a pre-existing not for resuscitation order.

OBJECTIVE: Compare and contrast rapid response team (RRT) calls to patients with, and those without, a pre-existing not for resuscitation (NFR) order. METHODS: Retrospective medical record and database review of adult inpatients with a hospital stay greater than 24h. RESULTS: 198 (15.7%) of 1258 patients with a RRT call, had a pre-existing NFR order. Patients with, compared to those without a pre-existing NFR, were older (median years, 81 vs 70, p<0.01), similar gender (males, 56.6% vs 54.3%, p=0.55), the trigger be the worried criterion (48.5% vs 33.9%, p<0.01) and have had a prior RRT call (30.8% vs 18.0%, p<0.01). At time of RRT attendance, NFR patients had a higher respiratory rate (24 vs 20, p<0.01), lower SaO2 (93% vs 97%, p=0.02) and just as likely to receive a critical care (24.2% vs 25.8%, p=0.63) or ward type (88.9% vs 90.1%, p=0.61) intervention. NFR patients were less likely to be admitted to an ICU (2.0% vs 9.4%, p<0.01), more likely to be left on the ward (92.4% vs 80.3%, p<0.01), and be documented not for further RRT calls (2.5% vs 0.9%, p=0.06), but have a similar mortality (5.6% vs 3.5%, p=0.16), at time of RRT call. CONCLUSIONS: RRT calls to patients with pre-existing NFR orders are not uncommon. The worried criterion is more often the trigger, they have abnormal respiratory observations at time of call, a similar level of intervention, less likely to be admitted to the ICU and more likely to be documented not for further RRT calls.