Over view of major traumatic injury in Australia--Implications for trauma system design.

BACKGROUND: Trauma registries are known to drive improvements and optimise trauma systems worldwide. This is the first reported comparison of the epidemiology and outcomes at major centres across Australia. METHODS: The Australian Trauma Registry was a collaboration of 26 major trauma centres across Australia at the time of this study and currently collects information on patients admitted to these centres who die after injury and/or sustain major trauma (Injury Severity Score (ISS) > 12). Data from 1 July 2016 to 30 June 2017 were analysed. Primary endpoints were risk adjusted length of stay and mortality (adjusted for age, cause of injury, arrival Glasgow coma scale (GCS), shock-index grouped in quartiles and ISS). RESULTS: There were 8423 patients from 24 centres included. The median age (IQR) was 48 (28-68) years. Median (IQR) ISS was 17 (14-25). There was a predominance of males (72%) apart from the extremes of age. Transport-related cases accounted for 45% of major trauma, followed by falls (35.1%). Patients took 1.42 (1.03-2.12) h to reach hospital and spent 7.10 (3.64-15.00) days in hospital. Risk adjusted length of stay and mortality did not differ significantly across sites. Primary endpoints across sites were also similar in paediatric and older adult (>65) age groups. CONCLUSION: Australia has the capability to identify national injury trends to target prevention and reduce the burden of injury. Quality of care following injury can now be benchmarked across Australia and with the planned enhancements to data collection and reporting, this will enable improved management of trauma victims.

Emergency intubation: a prospective multicentre descriptive audit in an Australian helicopter emergency medical service.

OBJECTIVE: To describe the safety profile of emergency airway management when performed by a prehospital team consisting of a doctor and a paramedic. Success rates, the incidence of difficult airways and the ability of prehospital doctors to determine a difficult airway are reported. METHODS: A prospective audit and descriptive study of three Australian helicopter emergency medical service (HEMS) bases, over a 9-month period. Doctors completed questionnaires regarding the number of endotracheal intubation (ETI) attempts on patients transported intubated and ventilated, Cormack and Lehane view of the cords during laryngoscopy and the anticipated and actual ease of ETI. RESULTS: A total of 114 (11.4%) patients transported by the HEMS was intubated and ventilated. Study questionnaires were completed on 89 of the 114 cases (78.1%), of which 32 (36%) were trauma related. HEMS were involved with 43 (48.3%) of the 89 intubations and performed 12.4% (n = 11) out of hospital. The HEMS ETI success rate was 97.6%. No surgical airways were performed. The actual incidence of difficult airways was higher (n = 4, 9.3%) than the anticipated incidence (n = 1, 2.3%). Six patients (14.0%) were successfully intubated by the doctor after the paramedic failed. CONCLUSIONS: Well-trained doctor paramedic teams, utilising standardised operating procedures, can safely perform rapid sequence induction and ETI in the prehospital and emergency environment. However, prehospital doctors are not always able to anticipate a difficult airway. The complication rate was similar to that in hospital emergency departments and to that of other physician-led HEMS.

Procedural sedation in paediatric minor procedures: a prospective audit on ketamine use in the emergency department.

OBJECTIVES: To further evaluate the safety profile and efficacy of intramuscular ketamine for procedural sedation during paediatric minor procedures in the emergency department and to ascertain parental satisfaction with the treatment of their children. METHODS: A prospective audit of ketamine use in a UK district general hospital involving 89 children requiring minor procedures. Children received topical anaesthesia followed by an intramuscular injection of ketamine 4 mg/kg and intramuscular atropine 0.02 mg/kg. The procedure was assessed by way of a physician completed form and by evaluation of questionnaires given to parents to gauge levels of satisfaction. RESULTS: No child required admission to hospital and there were no serious complications. A high level of satisfaction was expressed by all the parents/guardians of the children treated. CONCLUSIONS: High levels of satisfaction among parents and staff together with the avoidance of hospital admission and improved resource management should be a sufficient incentive for hospital trusts to consider the establishment of this type of service.