Thread by @GongGasGirl

Adam Mahoney. Trauma. #ACE22TAS

Tasmanian Trauma System has been evolving.

2014 One State One Health System
2014 - 2016 Clinical advisory groups
2016 - 2017 Statewide trauma service
2017 - 2018 Transition to local governance (3 parts)

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2018 - 2019 RHH department of trauma services
2019 RACS trauma verification
2020 Tas trauma registry
2021 Trauma case mgmt, trauma network
2022 Trauma bed card approved

Better coordination as a statewide trauma community now. Multidisciplinary (yay nurses!).

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Two main documents currently used. Adam suggests delegates read to see where their facility lies.

Acuity based ambulance redirection and early retrieval activation.
Tasmanian role delineation framework and clinical services profile.

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Tasmania ivided into northwest, north and south for trauma.
Launceston is a Level 5, Hobart a Level 6. North-west is a level 4 - need to be able to do damage control, and transfer.

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Trauma systems are an integrated and systematic structure designed to facilitate and coordinate a multidisciplinary system response to provide optimal care to injured patients.

But is this work as done or work as imagined in Tasmania?

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Looks like trauma in Tasmania is mostly run on ‘phone a friend’ at the moment with enthusiasts driving it.

Structures aren’t yet fully developed.

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Huge strengths in Tasmania with highly motivated individuals who have usually come across each other.

(It’s always the people isn’t it ….)

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Donald Rumsfeld problem - we don't know what we don't know. Big problem with data collection, outdated guidelines...

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Trauma is all about multidisciplinary engagement (again shout out to all the not doctors ….) #ACE22TAS

Trauma is a team sport.

These fabulous people make all the good things happen in Tasmanian Trauma ….

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Is the trauma care in Tasmania effective, safe, efficient, equitable, acceptable, accessible?

Large dispersion of population, can't just focus on big places - is there variation in outcome if retrieved from a long way? Data not currently collected. We just don't know.

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Adam is a lover of trauma registries. Can’t get the knowledge (and therefore the wisdom) unless we collect the data.

We can’t make assumptions just based on the cases we see …. Data, analysis, follow up essential.

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The data shows us that what is happening is not actually what we expect, not necessarily young guy off a motorbike …, Tasmania is older - average age is 50’s.

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Slightly longer to get to definitive care (due to distance) compared to rest of Australia.

Mechanism of injury? Assault each other less, and ride bikes more in Tasmania compared to rest of Australia.

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Trauma mortality

Death risk increases with advancing age in Tasmanian trauma.

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Is your trauma call system working?

Need to look at the undertriage rate also …

Do we undertriage older people? Yup… knowing this means we can intervene ….

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Does it matter if you get a trauma call?

Oh you bet it does: if you don't get a trauma call, spent 4 x as long in Hobart ED than if you do.

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(Listening to Adam's talk I'm reminded of how health is lifted up with enthusiasts pushing for change, advocating for better .... and also how data driven and smart he is .... )

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Vision of Trauma Care in Australia

Creating a safer Tasmania.
Ensuring wellbeing after injury. (what do our patients want, not just what we want).

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The future of trauma in Was:
Trauma workforce increasing. Data management to be improved. Developing a robust T-TQIP.

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TRAUMA SAYS YES.

Adam wants to not have patient ping pong .. pathways aim to care for all who need it ... avoid tensions between which team will take.

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Trauma in Tasmania?

The glass is indeed half full.

So many good people, not afraid to examine the data, ask uncomfortable questions, a vision and plan for the future.

Great talk thank you Dr Adam Mahoney Director of Trauma Hobart Hospital.

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