trauma teams in australia: a national survey

ANZ J. Surg.

2003;

73

: 819–825

ORIGINAL ARTICLE

ORIGINAL ARTICLE

TRAUMA TEAMS IN AUSTRALIA: A NATIONAL SURVEY

K

ENNETH

W

ONG

AND

J

EFFREY

P

ETCHELL

Department of Trauma, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia

Background:

Trauma teams have been associated with improved trauma patient outcomes. The present study seeks to estimate theuse of trauma teams in Australian hospitals and describe their medical composition, leadership and criteria for activation.

Methods:

Australian public hospitals with more than 100 beds, an emergency department and offering surgical services wereidentified. A survey assessing the presence, composition and means of activation of a trauma team was mailed to the ‘Director,Emergency Department’ of all identified hospitals. Three months later, all hospitals were contacted by telephone to complete andverify data collection.

Results:

Questionnaires were distributed to 130 hospitals. After exclusion of hospitals that did not receive patients with traumaticinjuries, and dedicated paediatric tertiary referral centres, 111 hospitals remained for analysis. Of these, 56% had an establishedtrauma team, while 71% of hospitals without a trauma team claimed to have insufficient doctors to form one team. Ninety-five percent of trauma teams were potentially activated by prehospital paramedic data (field triage). For 92% of trauma teams a combinationof anatomical, physiological and mechanistic criteria were required for activation. The most common methods of mobilizing atrauma team were by dispatching a common call onto individual pagers (31%) or by paging trauma team members individually(31%). Fifty-eight per cent of trauma team leaders were emergency medicine specialists/registrars, while 8% of trauma teams wereled by surgeons/registrars. Consultant surgeons were members of 23% of trauma teams and 74% of trauma teams consisted of morejunior members after hours. Some form of trauma audit was engaged in by 64% of hospitals.

Conclusions:

Trauma teams are yet to be utilized by many Australian hospitals that provide trauma care. Australian surgeonspresently have limited leadership roles and membership in trauma teams. Trauma audit can be more widely adopted in Australianhospitals.

Key words: audit, trauma, trauma team, trauma triage.

Abbreviations

: ATLS, advanced trauma life support; EMST, early management of severe trauma.

INTRODUCTION

A trauma team refers to a multidisciplinary group of health pro-fessionals who can provide immediate, expert assessment, resus-citation and treatment of a patient with multiple injuries.

1,2

Themerits of trauma teams in the early management of trauma arewell established in the literature.

3,4

The present study seeks todocument the existence of trauma teams in Australian hospitalsand to describe their composition, leadership, mode of activation,criteria for activation and audit of trauma team activity.

METHODS

Using the 22nd edition of the

Medical Directory of Australia

,

5

hospitals that were listed as public hospitals, having at least 100beds and offered both Emergency and Surgical services wereidentified. A survey addressed to the ‘Director, EmergencyDepartment’ was mailed to all these hospitals. The survey con-sisted of questions about different aspects of trauma teams,including: (i) existence of a trauma team; (ii) reasons for lack of atrauma team (if nonexistent); (iii) field and hospital triage criteriafor trauma team activation; (iv) means of activating the traumateam; (v) leadership of the trauma team; (vi) medical composition

of trauma team, in terms of speciality and grade of doctor; (vii)variation of the trauma team at different hours of the day; and(viii) audit of trauma team activities. For each category, multipleanswers were offered and the respondent was asked to choose oneor more options, with space given for additional comments. Datacollection took place over a 6 month period ending in January2002. Three months later, all hospitals, respondent and non-respondent were contacted by telephone to verify received dataand in the nonrespondent hospitals, to complete data collection.At each hospital, the ‘Director, Emergency Department’ was con-tacted. If he or she was unavailable, then an emergency consult-ant, registrar, doctor in charge or nurse in charge was contacted.

Analysis of data was performed using Microsoft Excel 2002(Redmond, WA, USA).

RESULTS

Using the

Medical Directory of Australia

, 130 hospitals wereidentified that satisfied the criteria for inclusion in this study,namely: (i) 100 or more beds; (ii) public hospital; (iii) presence ofan emergency department; and (iv) presence of surgical services.There was a written response rate of 57% (74 hospitals). Theremaining hospitals were contacted by telephone to achieve anoverall 100% response rate. Twelve of 130 hospitals indicatedthat they received no trauma patients or were totally ‘traumabypass’. Seven hospitals were dedicated paediatric tertiary refer-ral centres. These hospitals were excluded from further analysis.The present study analyses the remaining 111 hospitals. Of thesehospitals 56% (62/111) had trauma teams. A written responsewas given by 71% (44/62) of hospitals that had a trauma team. In

K. Wong

MB BS;

J. Petchell

FRACS.

Correspondence: Dr Kenneth Wong, 6 Stella Close, Killara, NSW 2071,Australia.Email: [email protected]

Accepted for publication 20 May 2003.

820 WONG AND PETCHELL

contrast, 49% (24/49) of hospitals without a trauma team pro-vided a written response.

Table 1 lists the discipline (medical or nursing) and grade ofthe respondent providing information for the 111 hospitals.Table 2 shows the number of hospitals by state that have traumateams. Table 3 shows the reasons given by the 51 hospitals thatdid not have a trauma team.

Of the hospitals 95% (59/62) indicated that the trauma teamwould be placed on standby or assembled in response to pre-hospital information communicated by paramedical services.Ninety-two per cent (57/62) of Australian trauma teams are acti-vated by a combination of anatomical, mechanistic and physio-logical criteria.

The physical mechanisms by which members of trauma teamsare notified are shown in Table 4. In 61% (38/62) of Australiantrauma teams mobilization occurs by means of a simultaneouspaging mechanism activated by the hospital switchboard, forexample a group page on their individual pagers or a specifictrauma team pager.

The medical leadership of Australian trauma teams by medicalspecialty is shown in Table 5. The grade of trauma team leaderbecomes more junior outside of business hours in 66% (41/62) ofAustralian trauma teams. Within Australian trauma teams 23%(14/62) have a consultant grade specialist present at all traumaresponses at all times.

The number of doctors listed as primary members of trauma teamsranges from one to 10 members with a mean of five members. Table 6shows the medical composition of the 62 Australian trauma teams bymedical specialty and grade. Registrar (specialist trainees) level staffin all specialties, except emergency medicine, constitutes the major-ity of Australian trauma team members. Of the Australian traumateams 74% (46/62) change their medical composition outside ofbusiness hours, that is, have less personnel or more junior personnel.

Sixty-four per cent (71/111) of respondent hospitals conductaudit activities relating to trauma outcomes. Eighty-four per cent(52/62) of hospitals with trauma teams conduct trauma audit. Bycomparison, 39% (19/49) of hospitals without trauma teamsconduct trauma audit.

Table 2.

Trauma teams in each Australian state or territory

State or territory Hospitals with a trauma

team (%)

No. hospitals

with a traumateam

Total no. hospitals analysed

Australian Capital Territory 100 1 1New South Wales 61 22 36Northern Territory 100 2 2Queensland 48 10 21South Australia 60 6 10Tasmania 100 3 3Victoria 47 14 30Western Australia 50 4 8Total 56 62 111

Table 1.

Grade and discipline of survey respondents (111hospitals)

Grade and discipline

n

Director of emergency department or emergency medicine consultant

78

Emergency registrar or resident medical officer 21Nurse in charge 12

Table 4.

Mechanism of mobilizing trauma team members

Mechanism by which trauma team is activated No. trauma teams

Usual pagerGroup paging 19Individual paging 19Individual paging plus in-hospital announcement 1Group paging plus in-hospital announcement 1

Specific trauma team pagerTeam pager only 14Plus individual pager 3Plus in-hospital announcement 1

Telephone 4Total 62

Table 5.

Medical specialty of trauma team leaders

Medical discipline of trauma team leader No. trauma teams

Emergency medicine 36Rotating among surgery/emergency medicine/ICU 12Ad hoc

†

9Surgery 5

†

This category refers to trauma teams which determined the leader after thearrival of all members of the team, that is, there is no predetermined leader.ICU, intensive care unit.

Table 3.

Reasons for lack of a trauma team

Reasons for lack of a trauma team No. hospitals

Not enough doctors in hospital to form a trauma team 35Too few trauma patients 15Surgeons have commitments elsewhere/no interest in

trauma11

Not enough expertise in hospital to form trauma team 9Emergency department staffing adequate to handle trauma 8On call staff readily available, therefore no need for a

formal trauma team5

Too close to a major trauma service 2

Table 6.

Grade and medical specialty of Australian trauma teammembers

Specialty Consultant Registrar Resident

Emergency medicine 54 49 23General surgery 14 56 3Anaesthetics 17 36 0Intensive care 13 23 0Neurosurgery 1 1 0Orthopaedics 1 8 0

EARLY MANAGEMENT OF TRAUMA 821

The number of hospitals that conduct audits of trauma activityis ordered by state in Table 7.

DISCUSSION

The advantages of an early, multidisciplinary response to patientswith multiple injuries are well documented in the literature.

1–4,6

This type of response is also in accordance with Early Manage-ment of Severe Trauma (EMST)/Advanced Trauma Life Support(ATLS) guidelines.

7

Surveys on trauma deaths suggest that errorsin initial resuscitation and in mobilizing doctors of relevantspecialty and experience account for the majority of preventabledeaths.

8–10

By increasing the speed of initial resuscitation, limiting errorsin resuscitation and facilitating the mobilization of doctors of rel-evant specialty and experience, trauma teams directly improvepatient outcome and survival.

1–4,6

Previous reports have sug-gested that the uptake of the concept of a trauma team has beenslow.

1,4,11

Information regarding the existence and characteristicsof Australian trauma teams might facilitate improvement in thequality of trauma care in Australia.

Response to survey

The 57% written response rate to this survey is consistent with asimilar British survey (55%)

11

but lower than a similar Americansurvey (84%).

12

Telephone follow up was used to verify the accu-racy of survey responses as well as allowing completion of datacollection for all hospitals. The telephone survey mode is com-plementary to the written survey mode in allowing compilation ofmore complete information and enhancing the quality of informa-tion.

13,14

It was decided to direct the survey towards ‘Director, Emer-gency Department’ since existing literature suggests that emer-gency physicians, more than any other medical specialty appearto be the most commonly involved in trauma team res-ponses.

11,12,15

Therefore, the responses analysed in this studyreflect emergency specialists’ views of trauma responses in theirhospitals. The 29% of respondents who were registrars/residentand senior nurses reflect two factors: (i) some hospitals do nothave consultant emergency physicians; or (ii) consultants wereunavailable or difficult to contact. All respondents were the mostsenior contactable personnel based in the emergency department

at the time of the survey. Therefore, the results presented in thisstudy might not represent the opinions of other medical and non-medical personnel involved in Australian trauma teams.

Presence of trauma teams

Of the Australian hospitals surveyed 57% indicate the presence ofa trauma team or an organized medical response to trauma. Thisis lower than similar studies performed overseas – 61% ina United Kingdom survey

11

and 72% in an American survey.

12

Although two Australian states have described improved traumapatient outcomes by regionalization of trauma care,

9,16

there is noinformation as to the usage of trauma teams within these evolvingtrauma systems. Trauma teams are an integral aspect of dedicatedtrauma centres.

3

Various Australian policy documents, includingthe

Report of the Working Party on Trauma Systems

by theNational Road Trauma Advisory Council,

17

the Royal Australa-sian College of Surgeons’ (RACS)

Policy on Trauma

18

and the

Review of Trauma and Emergency Services 1999: Final Report

19

by the Department of Human Services, Victoria; have recom-mended the implementation of organized trauma systems,wherein a coordinated and integrated clinical service acrosshospitals, can optimize patient outcome by facilitating the earlydelivery of severely injured patients to a designated hospital,that can expedite appropriate care. Within an organized traumasystem, these policies recommend that all hospitals designated toreceive major trauma patients should have a formal trauma teamresponse.

17–19

Furthermore, trauma team composition shouldbe sourced from multidisciplinary specialists (surgeons, anaes-thetists, intensivists, emergency physicians) in order to provideoptimal expertise within the team.

17–19

However, currently, nosingle, uniform process of designation of trauma centres andtrauma systems has been implemented throughout Australia, and,therefore, it is not possible to analyse the relationship between theexistence of trauma teams and dedicated trauma centres in differ-ent states and territories. The American College of Surgeons hasimplemented a programme of ‘trauma centre verification’ since1987, whereby hospitals are classified according to defined crite-ria as to the level of resources and commitment provided fortrauma care.

20

The process of achieving Level 1 verification byindividual hospitals, that is, designation of lead trauma centrestatus within a region, has been shown to improve patient out-come.

20

A similar process of ‘verification’ in Australia, con-ducted by the RACS Trauma Committee

18,21,22

might facilitatecomparison of the uptake of trauma teams in different Australianstates in future studies. A hospital undergoing verification isreviewed by a multidisciplinary team of clinicians, includingsurgeons, anaesthetists, intensivists, emergency physicians andnurses.

22

The verification team assesses the hospital’s traumaservices from the prehospital phase through to patient dis-charge.

22

The existence and composition of the hospital’s traumateam is reviewed. The verification process identifies the strengthsand weaknesses of a hospital’s trauma service, acting as a qualityassurance mechanism that allows hospitals to benchmark theirservices against established standards.

22

Absence of trauma teams

The various reasons cited by Australian hospitals for not havinga trauma team are comparable to overseas reports.

6,11,23

‘Nothaving enough doctors available’ (71%; 35/49), ‘too few traumapatients’ (31%; 15/49) and ‘not enough doctors of sufficient

Table 7.

Percentage of hospitals in each Australian state/territorythat conduct trauma audit

State/territory Hospitals conducting audit (%)

No. hospitals

conducting audit

Total no. hospitals in state/territory

included in this study

Australian Capital Territory 100 1 1

New South Wales 81 29 36Northern Territory 100 2 2Queensland 57 12 21South Australia 50 5 10Tasmania 100 3 3Victoria 47 14 30Western Australia 63 5 8Total 64 71 111


expertise’ (18%; (9/49) were common reasons given for non-existence of a trauma team. These reasons should not discouragethe formation of a trauma team. In fact, in these hospitals, it iseven more crucial to formulate a predesignated response totrauma. A trauma team response allows the concentration ofscarce resources on the time critical resuscitation of patients withmultiple injuries.

6,11,23

Initiatives at a local level – hospital traumacommittees,

4,18

the appointment of a director of trauma,

18

multi-disciplinary trauma education activities

2,21

and at a national level– the RACS ‘Trauma Verification Programme’

22

and the devel-opment of EMST courses

7

might encourage more Australian hos-pitals to organize a formal trauma team response. Lack of interestfrom surgeons was cited by 22% (11/49) of hospitals for nothaving a trauma team. Previous reports have suggested that sur-geons believe trauma to be disruptive to established routines andprevents prior commitments. They are sceptical of the value of atrauma team and are uncertain of the role of the surgeon in theemergency department.

11,12,23

However, as this survey wasdirected at emergency physicians, the issue of the perceived lackof surgical interest in trauma might be further assessed by direct-ing future similar surveys at surgical personnel.

Trauma team activation

Trauma teams are usually activated in response to predeterminedpatient related criteria. These criteria may be utilized in the pre-hospital phase (field triage criteria) or upon arrival in hospital(triage). Predetermined criteria aim to eliminate any subjectiveelement in decision making as to when to activate the traumateam.

4

Under-activation or under-triage by the trauma team mightcompromise patient outcomes by delaying diagnosis and resusci-tative measures. Over-activation or over-triage can be perceived,in retrospect, to be a waste of resources. The majority of Austral-ian trauma teams are activated by prehospital information. Thisseems ideal as it offers an opportunity for early assembly of thetrauma team in anticipation of the arrival of the injured patient.

4

However, not all patients identified by field triage criteria needfull trauma team activation.

24

Paramedic judgement of injuryseverity is a low yield single criterion but might enhance mech-anistic criteria.

25

Various suggestions have been proposed toincrease the efficiency of trauma team activation. Anaesthetist-attended ambulances and medical involvement in the field triageprocess are significantly associated with correct triage and higherpositive predictive value.

26,27

Secondary emergency departmenttriage (super triage), clinical and anatomical screening, mightfurther identify those that can be managed by routine emergencydepartment protocols and subsequent surgical referrals.

24

Two-tiered response teams, where only parts of a trauma team are acti-vated with the full team activated only if deemed necessary, havebeen shown to be safe, cost/resource effective and improves thesatisfaction of trauma team members by reducing their attendanceat trauma cases where they are not needed.

28–30

Trauma team triage

In-hospital triage is more specific to local infrastructure and theexpertise of the local trauma team. Hospital-triage criteria fortrauma team activation in the majority (92%) of surveyed Aus-tralian hospitals are a combination of anatomical, physiologicaland mechanistic criteria. Various triage screening criteria, incor-porating physiological, anatomical and mechanistic criteria, havebeen devised to maximize sensitivity, specificity and positive

predictive value to identify patients requiring trauma team activa-tion. However, none have been universally accepted.

24,29

There-fore, all trauma centres have to accept a certain degree of over-triage and under-triage. An over-triage rate of 50% might be nec-essary to achieve an under-triage rate of 5–10%.

31

Over-triagemight be accepted to a certain degree in some centres in orderto facilitate familiarity, better communication and role playingamong trauma team members with a view to improving trauma teamperformance.

32,33

A minority of Australian hospitals activate theirtrauma team by mechanistic criteria alone. However, this has beenshown to have a low positive predictive value for severe injury andmight worsen specificity without improving sensitivity.

24

Contacting the trauma team

An effective trauma team response requires early physical pres-ence of the trauma team members. Contacting each team memberindividually is clearly slower than a group contact mechanism.Most members of Australian trauma teams (61%) are activatedsimultaneously by their hospital switchboard. The remainingtrauma teams have members who are contacted individually. Asnoted in other reports, this might be due to technical difficultiesand the expenses associated with the introduction of groupcontact technologies.

4,23

Trauma team leadership

The trauma team leader plays a crucial role in the initial responseto trauma and the running of the trauma team. The trauma teamleader has a role in ensuring that all team members are workingsimultaneously (horizontal organization).

32,34

There is a positiverelationship between simultaneous task performance and thespeed of resuscitation. Subsequently, there is a positive relation-ship between the speed of resuscitation and patient survival.

32,34

Fifteen per cent of Australian trauma teams have no predefinedleader, meaning that leadership is determined among the person-nel in an ad hoc fashion at each trauma team response. The lackof a clearly defined leader might slow the speed of assessmentand resuscitation, with the possibilities that strong personalitiestake over and team members performing tasks with which theyare familiar, but unnecessary and thereby, compromise the resus-citation process.

35

Given that trauma teams consist of membersfrom multiple disciplines and specialities, the trauma team leaderhas a role in prioritizing investigations and resuscitative pro-cedures.

2

The present study suggests that many Australian traumateams could benefit from designation of a trauma team leader, inorder to improve coordination and teamwork.

Surgeons and trauma teams

The American College of Surgeons recommends that a consultantsurgeon be physically present for the initial trauma teamresponse.

36

No study has shown that the presence of a traumasurgeon in trauma team activations improves patient outcome ordecreases mortality. However, the presence of a trauma surgeonon the trauma team might reduce resuscitation time and time todefinitive operative intervention.

37

The present study shows thatAustralian surgeons/surgical registrars are the designated leadersin only 8% (5/62) of Australian trauma teams. A survey of Cana-dian trauma centres found that surgeons assumed the role oftrauma team leader an average of 57.% (

±

40%) of the time.

38

These figures might reflect a lack of surgical interest in trauma


and/or trauma teams.

11,23

There are training implications for thelack of consultant surgeons serving as trauma team leaders. Arecent survey of Australian advanced surgical trainees showedthat the majority felt that they received inadequate supervisionduring the initial resuscitation of major trauma.

39

Only 4% of firstyear trainees were supervised by a surgical consultant at morethan five trauma resuscitations.

39

However, it is noted that thephysical location of the surgical registrar or surgeon is usuallyoutside the emergency department, thereby making it difficult forsurgeons and/or their registrars to be trauma team leaders, espe-cially if the trauma team is expected to be awaiting the arrival ofthe trauma patient.

2

The use of a ‘second on call’ list, especiallyduring business hours, has been suggested by some authors.

4

The present study shows that emergency department special-ists/registrars lead most Australian trauma teams. Debate contin-ues as to whether surgeons or emergency medicine specialistsshould lead trauma teams.

12

Australasian EMST/ATLS guide-lines suggest that a ‘senior and experienced’ doctor should leadthe trauma team, regardless of specialty.

7

A prospective Austral-ian study on the performance of trauma team leaders has foundlittle difference in the performance of trauma team leaders fromeither specialty.

33

No relationship has been demonstrated betweenthe speed of initial resuscitation and the seniority/specialty of thetrauma team leader. Instead, it is the experience and training atrauma team leader/member that influences the function of thetrauma team.

32,34

Therefore, strict specialty based trauma teamleadership might cause problems, for example, when the surgicalregistrar is in theatre or a new/relieving/locum registrar is occu-pying the position.

4

Size and medical composition of trauma teams

There is neither an optimal size nor optimal medical compositionof trauma teams. The number of doctors listed as primarymembers of Australian trauma teams ranges from one to 10, witha mean of five. It is the organization of trauma team membersrather than the number present that is the crucial factor in reduc-ing resuscitation times and thereby improving outcomes.

32,34

Large teams are not cumbersome provided there is good leader-ship and that each member of the team is made aware of theirprimary role and tasks (horizontal allocation).

32,34

Small traumateams appear to produce similar results to large trauma teamsin treating trauma patients with severe injuries within the samehospital environment.

40

Ninety-four per cent of Australian trauma teams involvegeneral surgical personnel – general surgeons (14/62) and generalsurgical registrars (56/62). Only a minority of Australian traumateams (13%) have orthopaedic surgical personnel involved intheir primary trauma response. Sixty-eight per cent (42/62) ofAustralian trauma teams involve anaesthetic consultants and/orregistrars while 53% (33/62) of Australian trauma teams involveintensive care consultants and/or registrars. These results differfrom overseas reports. Orthopaedic surgeons and/or registrars aremore frequently represented in British trauma teams than generalsurgeons and/or registrars.

11

A survey of all American emergencymedicine residency programmes

12

estimated that 54% of theirtrauma teams involved consultant general surgeons and 38%involved anaesthetic consultants. Common to both the presentstudy and overseas experience, is that emergency medicine con-sultants and trainees constitute the majority of trauma teammembership.

11,12

Further involvement of anaesthetists and sub-specialty surgeons in Australian trauma teams would be consist-

ent with EMST/ATLS guidelines.

7

A Swedish study has notedimprovements in trauma care arising from early participation ofmultispecialty team members and improved communicationamong different medical specialties.

41

These findings might beapplicable to the Australian experience.

Surgical training and trauma teams

The RACS trauma committee recommends that basic surgicaltrainees and advanced surgical trainees are involved in 50 traumaresuscitations.

21

However, this study shows that only one-third ofAustralian trauma teams consist of resident medical staff (juniordoctors with no specialty affiliations). This suggests that basicsurgical trainees (surgically streamed doctors, with at least1 year’s postgraduate experience who are yet to enter advancedsurgical training) have little opportunity to be involved in theresuscitation of major trauma. A study of resident medical offic-ers working in an Australian major trauma service revealed thatthey had minimal experience in trauma resuscitative proce-dures.

42

A survey in the south-west region of the United Kingdomrevealed that only a quarter of surgical staff involved in theirtrauma teams were basic surgical trainees.

15

This can lead to theappointment of advanced surgical trainees who have had no priorexperience in the early management of major trauma.

15

Whilenot advocating a reduction of seniority of doctors in Australiantrauma teams, future planning of Australian trauma teams shouldconsider the training needs of resident medical officers, many ofwhom will participate in trauma care later in their careers.

Variation in trauma teams

The change in the medical composition outside of business hoursis of concern, with 74% of Australian trauma teams changingtheir composition and seniority outside of business hours. Like-wise, 77% of Australian teams might not necessarily have con-sultant grade involvement at all hours. Major trauma happensfrequently outside of business hours.

2,8

Therefore, more juniormembers are left to manage major cases at vulnerable periods oftime.

10

A solution could be to appoint 24-h cover from emergencymedicine specialists who would have the appropriate seniority,experience and authority to decide appropriate activation of thefull trauma team.

8

The American College of Surgeons recom-mends 24-h, in house general surgeon availability in Level Itrauma centres.

36

This recommendation needs to be furtherexplored as to its applicability to the Australian experience, sincethe volume of major trauma is lower than many American cen-tres. In Australia only a small proportion of trauma requiresgeneral surgical intervention.

39

Some authors have suggested thatmandatory in-house availability does not improve patient care,increases surgeon dissatisfaction, burnout and ultimatelydecreases the number of qualified surgeons who are willing toprovide trauma care.

43

Therefore, a permanently on-site generalsurgeon might not improve trauma care in Australian traumacentres.

Trauma audit

The majority (64%) of Australian hospitals undertake audit activ-ities of trauma outcomes. Mostly, this is conducted as part ofemergency department audit activities or general surgical audit.Audit of trauma team activity is important for several reasons.Trauma teams must be shown to be functioning properly and


producing demonstrable benefits for patients.

4

Monitoring over-triage and under-triage rates prevents suboptimal patient out-comes and limits wastage of resources. Trauma team leadersand members require feedback on their performance.

44,45

Thisrequires prospective data collection and audit.

4

More widespreadintroduction of video-tape analysis might be useful as an effectiveaudit tool that allows remote real-time analysis of trauma teamperformance as well as being an affective educational tool.

44,45

CONCLUSIONS

This survey suggests that the concept of a trauma team is yet to beadopted by many Australian hospitals involved in trauma care.Reasons for lack of trauma teams in surveyed hospitals do notappear to be insurmountable. The authors believe that the datapresented in this study provides baseline information for futureevaluation and modification of different characteristics of Aus-tralian trauma teams. Future similar surveys in Australia couldexamine the progress of trauma team utilization in Australianhospitals and explore other features of Australian trauma teams;namely, utilization of two-tier trauma teams, functional organiza-tion and task allocation of Australian trauma teams; use of com-puterized human patient simulators in the improvement of traumateam function;

46

protocols that might be useful in directingtrauma team activities; the methods of training trauma teams;active involvement of the trauma team leader in resuscitationtasks; involvement of other medical and surgical specialties inAustralian trauma teams and funding of trauma teams.

ACKNOWLEDGEMENTS

The authors would like to thank Sue Roncal for her assistance incoordinating data collection for this study and the staff of theRACS library for their expeditious supply of articles via theonline journal retrieval service.

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