Deaths from major trauma in NSW trauma centres have declined since 2003, and definitive care at a Level 1 trauma centre was associated with a survival benefit according to a recent article in The Medical Journal of Australia.
Level 1 trauma centres are confined to large metropolitan centres. On the NSW North Coast in 2009 there were 'adult patient' regional trauma centres listed at Coffs Harbour Base Hospital, Lismore Base Hospital and The Tweed Hospital. These appear to remain the only trauma centres in the region.
During the period studied the number of interhospital transfers between regional trauma centres and Level I centres did not increase significantly despite such transfers being shown to potentially halve the mortality rate.
Because of the systematic neglect of regional NSW by successive state governments and across the board cuts to public service delivery by the current O’Farrell Coalition Government, this is the risk North Coast residents are exposed to if they are involved in a serious motor vehicle/work/sports/in home accident:
Regional trauma centres play an important role in the delivery of trauma care, but often lack specialty resources. Most are located outside Sydney, and road travel time from regional trauma centres to a Level I centre ranges from 30 minutes to 2 hours. In a recent single region study in NSW, morbidity was significantly higher in a regional trauma centre compared with a Level I centre.10……..
Patients admitted to a regional trauma centre had a significantly higher mortality rate compared with those admitted to a Level I centre. The survival benefit at Level I centres could be explained by the presence of greater resources, such as the availability of surgically trained staff 24 hours a day, a multidisciplinary trauma service14,15 and higher patient volumes, resulting in enhanced expertise in trauma care.16 Deficiencies in trauma care, regardless of trauma centre level, may occur at multiple points of care and are more likely to occur when there is failure to comply with protocols, poor communication and/or delayed referral.10,14,17,18 However, without reviewing each of the deaths in this study, it is not possible to comment on factors contributing to mortality.
The benefits of primary transport or early interhospital transfer of patients with major trauma to a Level I trauma centre are confirmed in our study. In 2008 Ambulance NSW introduced “Protocol T1”, which specifies that patients with major trauma should be taken directly to a Level I centre, bypassing lower-level centres, if transport time is within 1 hour.19 The impact of Protocol T1 on patient transport practice and outcomes requires evaluation.
The geography of NSW means that regional trauma centres will continue to play an important role in initial stabilisation of patients with trauma. Our study suggests that improved adherence to transfer guidelines will contribute to improved patient outcomes consistent with the experience in Victoria17 and the United States.20 In recent years, a series of standardised transfer guidelines for patients with major trauma have been implemented in NSW, with variable compliance.10,21 The low numbers of transferred patients could also result from some patients with critical injuries being deemed too unstable for transfer, transfer being considered futile, or patients dying before a transfer decision was made.10,21
Initial trauma response and hospital transfers in regional areas are under pressure as the Ambulance Service of NSW is being asked to respond to increased demand with existing staff numbers.
Trauma services are one aspect of the true cost to local communities and local families of public service job cuts currently underway in the Clarence Valley and elsewhere and, why the almost cavalier attitude of North Coast Nationals MPs to these cuts is unacceptable and offensive.
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