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The Victorian State Trauma System
Professor Mark Fitzgerald ASM
MBBS MD FACEM AFRACMA
Director of Trauma Services
Director National Trauma Research Institute
Professor, Department of Surgery, Central Clinical
School, Monash University
2
ISS>12
2
27 June 2017 3
~USD $37,540,000,000
Local relevance
Governance
Measurable outcomes
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Prevention
Preprogramed response
Reduce secondary insults
pre and in hospital
Rapid transfer to a Major
Trauma Service
The right patient to the right
people in the right time
The Evolution of an Integrated State Trauma System in Victoria, Australia. Chris Atkin, Ilan Freedman, Jeffrey V. Rosenfeld, Mark
Fitzgerald, Thomas Kossmann. Injury; 36(11):1277-1287, November 2005.
Victorian State Trauma Registry - Distribution of Major Trauma*:
Definitive Care (Financial Years)
The data from the Victorian State Trauma Registry was provided by VSTORM, a Department of Health and Human Services and Transport Accident Commission funded project.
15
15,000
10,498
10,000
8,357
5,000
2,100 2,141
0
Total Injury
ISS>12 Major Non-Major
Admissions Attendances
FY2006 807 944 3,867 4,811 12,528
FY2012 925 1,132 5,399 6,531 15,682
FY2016 1,260 1,409 6,593 8,002 17,685
*2020 2,100 2,141 8,357 10,498 17,761
*Pre FY2014 reported ISS98 >15
16
CT Scans
x 50k
OECD 2009
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Odds of in-hospital death of major trauma patients
since introduction of the Victorian State Trauma System
Adjusted for injury severity, age and head injury
Source: Victorian State Trauma Registry
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Mock CN, Adzotor KE, Conklin E, Denno DM, Jurkovich GJ. Trauma
outcomes in the rural developing world: comparison with an
urban level I trauma center. J Trauma. 1993; 35: 518-23.
= Reduction in mortality compared to no
trauma system
Trauma management
Risk reduction and error avoidance
James K Styner
Nebraska 1976
Journal of Trauma Nursing
June 2006, Volume :13 Number 2,
page 41- 44
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Trauma management
Risk reduction and error avoidance
risk
time
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Surgery / Operative
Care Pre-Hospital
Care
Emergency / Critical
Care
Surgery / Operative
Care
Injury evolution, timing of presentation,
timeliness of intervention, time
management & coordination of resources
25
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Research in Trauma
Severe Pelvic Injury
25% 180
160
20%
140
120
15%
100
Mortality Pts.
80
10%
60
40
5%
20
0% 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
0
Pts 51 48 71 85 124 98 121 133 117 100 108 156
% Mortality 20% 17% 13% 16% 11% 7% 10% 5% 6% 8% 6% 8%
2002 2013 27 June 2017 27
(n=51) (n=156)
Age at presentation 42.7 (20.2) 48.2 (22.4) 0.13
(years)
Male sex 34 (67%) 93 (60%) 0.71
Time to hospital 119 (227) 112.3 (66) 0.72 Variable Adjusted OR 95% CIs p-value
(minutes)
Max Pelvic AIS 0.72
Year 2013 0.10 (0.02-0.60) 0.01
- 3 37 115 Age 1.05 (1.01-1.09) 0.01
- 4 12 31
2 10 ISS 1.08 (0.99-1.17) 0.08
- 5
Max head AIS 3 14 (27.4%) 32 (20.5%) 0.30 ICU Admission 0.24 (0.04-1.40) 0.11
Systolic BP on TCA 123 (37) 132 (33.7) 0.12 SI1 3.9 (0.63-24.5) 0.14
Mean Heart Rate on TCA 99 (28) 95 (25) 0.31 Heart rate >100 b/min 0.37 (0.04-3.13) 0.36
Systolic BP < 100 mmHg 7 (14%) 19 (12%) 0.74 Head AIS 3 1.2 (0.52-2.7) 0.69
IRAN
WHO Trauma Quality MYANMAR
Improvement Program Short Trauma Registry Development
Course Medical & Nursing Training
Trauma System Plan
SAUDI ARABIA
KSMC Trauma Center and
Research Institute
VIETNAM
ETHIOPIA Medical Services program
WHO Trauma Quality Improvement development in Vietnam
Program Short Course
PHILIPPINES
Australia-Philippine Trauma
Program
AFRICA
Development of African
Federation for Emergency
Medicine Handbook
MALAYSIA
WHO Trauma Quality Improvement
Program Short Course
m.fitzgerald@alfred.org.au