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5 – 7 October 2018Parmelia Hilton

Perth, Western Australia

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Program Book

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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 [email protected]


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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


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


1330-1500 Plenary Session 4 - National Road Safety Strategy Argyle Ballroom


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


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 Australasian Trauma Society - Annual General Meeting Argyle Ballroom

Program



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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


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 continued


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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


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


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



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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



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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


9am to 12pm


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


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


2pm to 3:45pm


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


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


7am to 8:25am


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


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


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


2 1

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


2 2

Floor Plan

Level 1, Parmelia Hilton Perth

REGISTRATION DESK


2 3

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: [email protected]

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



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



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



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



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



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



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.


2 6

LifeHealthcare – Stand 9

Contact: Bronwyn Pedersen

Address: Level 8 15 Talavera Road, North Ryde NSW 2113



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


1300 362 534


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



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



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



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


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


2 9

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


4 0

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.


4 1

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


4 2

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


4 3

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


4 4

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.


4 5

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).


4 6

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


4 7

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.


4 8

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.


4 9

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


5 0

TRENDS IN PREHOSPITAL TRAUMA DEATHS IN VICTORIA

Ben Beck1, Karen Smith1, 2, 3, Eric Mercier1, 4, Peter Cameron1, 5


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


5 1

(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


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


5 2

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.


5 3

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,


5 4

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



6. Department of Radiology, The Alfred, Melbourne, Victoria, Australia


5 5

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





5. Research, Ambulance Victoria, Melbourne, Victoria, Australia

6. Anaesthesia and Intensive Care, Royal Infirmary of Edinburgh, Edinburgh, Scotland


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.


5 6

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


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




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.


5 8

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






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


5 9

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





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


6 0

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


6 1

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.


6 2

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


6 3

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


6 4

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


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


6 5

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


2. Department of Physiotherapy, The Alfred, Melbourne, Victoria, Australia

3. National Trauma Research Institute, The Alfred, Melbourne, Victoria, Australia


5. Trauma Service, The Alfred, 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.


6 6

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.


6 7

Notes


6 8

Notes


6 9

Notes


7 0

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 [email protected]

www.traumasociety.com.au

ATS Secretariat, PO Box 576, Crows Nest NSW Australia 1585

Tel: +61 2 9431 8668 Email: [email protected]

Australian Trauma Society

Membership Application Form

FAX: +61 2 9431 8677

E MA IL: [email protected]

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


7 1

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 [email protected]

www.traumasociety.com.au

ATS Secretariat, PO Box 576, Crows Nest NSW Australia 1585

Tel: +61 2 9431 8668 Email: [email protected]

Australian Trauma Society

Membership Application Form

FAX: +61 2 9431 8677

E MA IL: [email protected]

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: [email protected]

www.worldtrauma2020.com

HOSTED BY:

SAVE THE DATE


7 2

3-6 October 2019 | Sofitel Sydney Wentworth, NSW, Australia

TRAUMA 2019Collaboration, innovation and the way forward

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