Accurate completion of tertiary trauma survey for inpatients at a non-trauma centre following significant trauma.

INTRODUCTION: A tertiary trauma survey (TTS) is a structured, comprehensive top-to-toe examination following major trauma [1]. Literature suggests that the ideal time frame for the initial TTS should be completed within 24-hours of a patient's admission and repeated at important moments [2-4]. Evidence suggests that formal TTS reduces the rate of missed injuries by up to 38% [2]. AIMS: To determine the rate of TTS being conducted in trauma patients in a tertiary hospital without an admitting trauma service. METHODS: We performed a retrospective analysis of adult trauma patients admitted to Middlemore Hospital (MMH) over six months. To be included, patients were either deemed to have a significant mechanism of injury or triggered a trauma call when arriving in the Emergency Department. RESULTS: We identified 246 patients who met our criteria for requiring a TTS. 74 (30%) had a TTS completed. Of those completed, 22 (30%) were documented using a standardised form. 35 (47%) were done within the ideal timeframe (24 h); a further 21 (28%) were done within 48 h. House Officers (Junior Medical Officers) conducted the majority (80%), with the remainder being done by final-year medical students (12%), Registrars (Residents) (4%) and Consultants (Attendings) (4%). Of the 74 TTS that were completed, 21 (28%) detected a possible new injury, with 22% leading to further investigations being ordered. 14 (19%) were found to have a previously undetected, clinically significant injury on TTS (defined as 'injuries requiring further clinical intervention'). Most patients (90%) were admitted to either General Surgery or Orthopaedics. Sixty-two (54%) of patients admitted to General Surgery received a TTS; compared to just 11 (10%) admitted under Orthopaedics and 1 of 24 (4%) admitted to other specialities (including Hands, Plastics, Maxillo-Facial, Gynaecology and Medicine). CONCLUSION: 30% of patients requiring a TTS received one. 19% of TTS conducted detected clinically significant injuries.

Providing rehabilitative services in rural communities: report of a conference.

Rural communities have a disproportionate need for rehabilitative services, partly attributable to an aging population and higher incidence of occupational injuries. Despite increased need, many rural communities find rehabilitative services unavailable due to personnel shortages, maldistribution of health care personnel, and related recruitment and retention issues. The National Rural Health Association and the Division of Associated, Dental, and Public Health Professions of the Health Resources and Services Administration co-sponsored a conference to explore issues related to ensuring that rural communities have access to vital rehabilitation services provided by allied health professionals. The status of rehabilitative care in rural settings and the barriers to improvement in services delivery were described by consumers, providers, educators, and public and private agency representatives. Recommendations directed to state and federal authorities, educational institutions, and professional organizations centered around increasing the supply of appropriately trained allied health providers. Improving retention of rehabilitative personnel in rural areas could be achieved by specific changes to the practice climate.

Extending access to care: preparing allied health practitioners for nontraditional settings.

Promoting access to quality health care is a primary emphasis in the allied health professions. However, many populations cannot access primary care services through traditional health care settings, due to financial, geographic, cultural, and manpower distribution barriers. Allied health programs typically prepare graduates to function in traditional health care settings. However, if one of the goals of allied health is to increase access to care, graduates need to be prepared to function in a variety of nontraditional settings. This paper examines the problems inherent in preparing allied health graduates for traditional roles, and presents a model educational program that provides practitioners with the knowledge and skills necessary to provide quality health care services in a variety of settings. Mechanisms for utilizing this model in allied health disciplines are addressed, as well as how this model promotes increased access to care.