NZ trauma care rated B-minus
8 September 2004
NZ trauma care rated B-minus
Director of Trauma services at Auckland City Hospital, Mr Civil says in its current state he would give the New Zealand Trauma Care system only a B minus.
Mr Civil says ironically the success of injury prevention initiatives over the past decade had raised a “whole bunch of new challenges” – the major one being a lack of cases for surgeons to work on.
“ Because trauma is not as common as it used to be we can’t always train new surgeons on the job. Patients still need an A plus service but there is the potential for them to get less good care because we are less experienced at working in the area,” he said.
“When I worked as a trainee I probably worked on 3 or 4 major trauma cases a day – now we probably see less than one a day in our unit. Our injury toll peaked in the 1980’s since then injuries have been continually trending down. So, from a training perspective it’s a case of the less you do, the less good you are at doing it,” he said.
New Zealand surgeons currently deal with about 1500 – 2000 major, life threatening, trauma cases a year
Mr Civil, who is also Chairman of the Royal Australasian College of Surgeons New Zealand Trauma Committee, said the College NZ Trauma Guidelines supported a tiered trauma system with most of the major trauma cases managed in an Advanced Trauma Service in one of the major centres, similar to the arrangement in Victoria. This arrangement has advantages from the training perspective and the data from the Victorian trauma registry suggests there are significant improvements in outcome possible as well.
“Although we often talk about the effective road safety initiatives of our Victorian neighbours we have done little to emulate their success particularly in the development of a national trauma plan, the designation and development of trauma care centres, quality assurance, a trauma registry, education systems, and on-going research into the treatment of trauma,” he said.
“If we are going to look after trauma patients effectively we need to make sure our pre-hospital care is well-coordinated with hospital care and rehabilitation.”
“On any day of the week there are trauma patients sitting in acute hospital beds when they should be being rehabilitated. In Victoria rehabilitation specialists come right into intensive care and select patients for early rehabilitation – here patients are sometimes sitting around for several weeks waiting for rehabilitation.”
Mr Civil said the time had come for a significant improvement in the development of trauma care for the benefit of all New Zealanders.
Mr Civil will present a paper on trauma training at the Royal Australasian College of Surgeons Annual Scientific Meeting (September 8-10). The College is hosting about 250 surgeons and invited specialists from Australia and abroad to discuss the cutting edge of medical science and to investigate the trends within the profession.