Commentary

Trauma care in the tropics: addressing gaps in treating injury in rural and remote Australia

AUTHORS

name here
Geoffrey Dobson1
PhD, FAHA, Professor, Heart and Trauma Research Laboratory *

name here
Clinton Gibbs2
MBBS, FACEM

name here
Lee Poole3
BH(Nurs), MNPractS

name here
Ben Butson4
BMBS, FACEM

name here
Luke Lawton5
MBBS, FACEM

name here
Jodie Morris6

name here
Hayley Letson7
PhD

AFFILIATIONS

1, 6, 7 Heart and Trauma Research Laboratory, College of Medicine and Dentistry, James Cook University, Townsville, Qld 4811, Australia

2 Retrieval Services Queensland (RSQ), Aeromedical Retrieval & Disaster Management Branch (ARDMB), Queensland Health, Townsville, Qld, Australia

3 Royal Flying Doctor Service Queensland Section, Brisbane, Qld, Australia

4 LifeFlight Retrieval Medicine, Townsville, Qld, Australia

5 Emergency Department, Townsville University Hospital, Townsville, Qld, Australia

ACCEPTED: 14 October 2021


early abstract:

In Australia, over half a million people are admitted to hospital every year as a result of injury, and where you live matters. Rural populations have disproportionately higher injury hospitalisation rates (1.5 to 2.5-fold), higher rates of preventable secondary complications, higher mortality rates (up to 5-fold), and higher costs (3-fold) than patients injured in major cities. These disparities scale up rapidly with increased remoteness, and shift the service needle from ‘scoop and run’ to ‘continuum-of-care’ . Poorer outcomes, however, are not solely due to longer retrieval distances or delays; but arise from inefficiencies in one or more potentially modifiable factors in the chain-of-survival. After discussing the burden of injury in Australia, we present a brief history of retrieval services in Queensland and discuss how remoteness requires a different kind of service delivery with many moving parts from point-of-injury to definitive care. We next address the ongoing challenges for the Australian Trauma Registry, and how centralisation of data from the metropolitan cities masks the inequities in rural and remote trauma. There is an urgent need for accurate data from all service providers around Australia to inform state and federal governments, and we highlight the paucity of trauma data analysis in North Queensland.  Lastly, we identify some major gaps in treating rural and remote polytrauma and en-route patient stabilisation, and discuss the relevance of combat casualty care research and practices. We conclude that a greater emphasis should be placed on collecting more robust trauma patient records, as only accurate data will drive change.