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

D EPARTMENT OF N EUROSURGERY North Queensland Region Townsville- Cairns- Mackay Progress and improved outcomes in STBI

D EPARTMENT OF N EUROSURGERY North Queensland Region Townsville- Cairns- Mackay Progress and improved outcomes in STBI

D EPARTMENT OF N EUROSURGERY North Queensland Region Townsville- Cairns- Mackay 750,000 sq klms 750,000 people

D EPARTMENT OF N EUROSURGERY North Queensland Region Townsville- Cairns- Mackay 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 The Statistics…

D EPARTMENT OF N EUROSURGERY 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

D EPARTMENT OF N EUROSURGERY 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

D EPARTMENT OF N EUROSURGERY 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 ) Pre-hospital Care…

D EPARTMENT OF N EUROSURGERY North Queensland Region Townsville- Cairns- Mackay Prospective 12 month study of neurotrauma Prospective, 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?

D EPARTMENT OF N EUROSURGERY 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 emergency operations by non-neurosurgeon)

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

D EPARTMENT OF N EUROSURGERY North Queensland Region Townsville- Cairns- Mackay Progress and improved outcomes in STBI

D EPARTMENT OF N EUROSURGERY North Queensland Region Townsville- Cairns- Mackay Acute neurotrauma communication algorithym

D EPARTMENT OF N EUROSURGERY North Queensland Region Townsville- Cairns- Mackay Training… EMST/ATLS course APLS course CCrISP course RACS policy on trauma

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

D EPARTMENT OF N EUROSURGERY North Queensland Region Townsville- Cairns- Mackay

D EPARTMENT OF N EUROSURGERY North Queensland Region Townsville- Cairns- Mackay

D EPARTMENT OF N EUROSURGERY North Queensland Region Townsville- Cairns- Mackay Is there a broader application? Evidence-based prehospital management of STBI: A comparative analysis of current clinical practice guidelines. April Varied considerably Adapted for local requirements Exists a need for collaboration