Pre-hospital Guidelines for Neurotrauma in Rural and Remote

Pre-hospital Guidelines for Neurotrauma in Rural and Remote Australia - broader application? Associate Professor Eric Guazzo Director Dept. of Neurosurgery Townsville Hospital , Australia DEPARTMENT OF NEUROSURGERY North Queensland Region Townsville- Cairns- Mackay

Progress and improved outcomes in STBI DEPARTMENT OF NEUROSURGERY North Queensland Region Townsville- Cairns- Mackay Progress and improved outcomes in STBI DEPARTMENT OF NEUROSURGERY North Queensland Region

Townsville- Cairns- Mackay 750,000 sq klms 750,000 people DEPARTMENT OF NEUROSURGERY North Queensland Region Townsville- Cairns- Mackay The Statistics Traumatic brain injury is responsible

for 50% of trauma deaths 70% of all road trauma deaths Traumatic brain injury is the commonest cause of permanent disability after injury DEPARTMENT OF NEUROSURGERY North Queensland Region Townsville- Cairns- Mackay Factors in the rural environment Isolated areas at a distance from

medical facilities Facilities may be limited Delay in definitive care DEPARTMENT OF NEUROSURGERY North Queensland Region Townsville- Cairns- Mackay Avoidable causes of death or disability Delay in

Instituting primary resuscitation for hypoxia, hypercarbia hypotension Initiating definitive neurosurgical care especially for the rapidly developing intracranial haematoma DEPARTMENT OF NEUROSURGERY North Queensland Region Townsville- Cairns- Mackay Pre-hospital Care

DEPARTMENT OF NEUROSURGERY North Queensland Region Townsville- Cairns- Mackay Airway Breathing Control of haemorrhage Prevention and treatment of

shock Prevention of hypothermia Avoiding factors which can either cause or increase intracranial pressure ( ie head-down position, hypoxia, hypercarbia ) Consider serious possible injuries ( spinal )

Prospective 12 month study of Prospective,neurotrauma inclusive of all significant head injuries Document epidemiology of neurotrauma within northern zone Investigate management given by whom adherence to management protocols transfer patterns need for emergency surgery Can we improve care?

DEPARTMENT OF NEUROSURGERY North Queensland Region Townsville- Cairns- Mackay What did we find? 178 patients Initial care often given by junior medical staff or registered nurse Often poor compliance to trauma system procedures eg, no documentation of GCS on initial hospital assessment, no cervical

spine imaging Delays in transfer and provision of definitive care Approximately 20% of patients needed definitive neurosurgical care (only 2 DEPARTMENT OF NEUROSURGERY North Queensland Region emergency operations by nonneurosurgeon) Townsville- Cairns- Mackay

What can we do? Continue to improve training and improve facilities Implement a system for our zone DEPARTMENT OF NEUROSURGERY North Queensland Region Townsville- Cairns- Mackay

Progress and improved outcomes in STBI DEPARTMENT OF NEUROSURGERY North Queensland Region Townsville- Cairns- Mackay Acute neurotrauma communication algorithym DEPARTMENT OF NEUROSURGERY

North Queensland Region Townsville- Cairns- Mackay Training EMST/ATLS course APLS course CCrISP course RACS policy on trauma DEPARTMENT OF NEUROSURGERY North Queensland Region Townsville- Cairns- Mackay

Introduction: Welcome to the Acute Neurotrauma eLearning Course. The aim of this course is to provide an introduction to Acute Neurotrauma care and patient management in the rural setting. On completion of this course you should have an understanding of: Epidemiology dealing with neurotrauma Standard diagnosis techniques Types of head injuries Pre-hospital care Primary hospital initial management Definitive Care

DEPARTMENT OF NEUROSURGERY North Queensland Region Townsville- Cairns- Mackay DEPARTMENT OF NEUROSURGERY North Queensland Region Townsville- Cairns- Mackay Is there a broader application? Evidence-based prehospital management of STB A comparative analysis of current clinical practic

guidelines. April 2014. Varied considerably Adapted for local requirements Exists a need for collaboration DEPARTMENT OF NEUROSURGERY North Queensland Region Townsville- Cairns- Mackay