Hostname: page-component-669899f699-tzmfd Total loading time: 0 Render date: 2025-04-26T04:53:39.778Z Has data issue: false hasContentIssue false
  • English
  • Français

Evaluation of the Prehospital Management of Road Traffic Fatalities in Victoria, Australia

Published online by Cambridge University Press:  28 June 2012

Francis T. McDermott ,
Gregory J. Cooper ,
Philip L. Hogan ,
Stephen M. Cordner  and
Ann B. Tremayne
Francis T. McDermott*
Affiliation:
Co-Chair, Consultative Committee on Road Traffic Fatalities in Victoria-Royal Australasian College of Surgeons and Victorian Institute of Forensic Medicine; Honorary Professorial Fellow, Department of Surgery, Austin Health, The University of Melbourne, Victoria
Gregory J. Cooper
Affiliation:
Operational Manager, Metropolitan Ambulance Service, Victoria
Philip L. Hogan
Affiliation:
Team Manager, Helicopter Emergency Medical Services, Air Ambulance, Victoria
Stephen M. Cordner
Affiliation:
Co-Chair, Consultative Committee on Road Traffic Fatalities in Victoria, Professor, Department of Forensic Medicine, Monash University; Director, Victorian Institute of Forensic Medicine, Melbourne, Victoria
Ann B. Tremayne
Affiliation:
Project Manager, Consultative Committee on Road Traffic Fatalities in Victoria, The Consultative Committee on Road Traffic Fatalities in Victoria
*
Consultative Committee on Road Traffic Fatalities, 57-83 Kavanagh Street Southbank, Victoria 3006, Australia E-mail: annt2@bigpond.com.au
Get access Rights & Permissions [Opens in a new window]

Abstract

Introduction:

This study was undertaken to identify prehospital system and management deficiencies and preventable deaths between 01 January 1997 and 31 December 1998 in 243 consecutive Victorian road crash victims with fatal outcomes.

Methods:

The complete prehospital and hospital records, the deposition to the coroner, and autopsy findings were evaluated by computer analysis and peer group review with multidisciplinary discussion.

Results:

One-hundred eighty-seven (77%) patients had prehospital errors or inadequacies, of which 135 (67%) contributed to death. Three-hundred ninety-four (67%) related to management and 130 (22%) to system deficiencies. Technique errors, diagnosis delays, and errors relatively were infrequent. One of 24 deaths at the crash scene or en route to hospital was considered to be preventable and two potentially preventable.

Conclusion:

The high prevalence of prehospital deficiencies has been addressed by a Ministerial Task Force on Trauma and Emergency Services and followed by the introduction of a new trauma care system in Victoria.

Keywords

advanced trauma life support (ATLS)ambulancebasic trauma life support (BTLS)evaluation studiesfatalitiesprehospitaltraffictrauma management
Type
Research Article
Information
Prehospital and Disaster Medicine , Volume 20 , Issue 4 , August 2005 , pp. 219 - 227
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2005

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

1McDermott, FT, Cordner, SM, Tremayne, AB, the Consultative Committee on Road Traffic Fatalities in Victoria: The evaluation of the medical management and preventability of death in 137 road traffic fatalities in Victoria, Australia: An overview. J Trauma 1996;40:520–535.CrossRefGoogle ScholarPubMed
2McDermott, FT, Cordner, SM, Tremayne, AB, the Consultative Committee on Road Traffic Fatalities in Victoria: Management deficiencies and death preventability in 120 Victorian road fatalities (1993–1994). Aust N Z J Surg 1997;67:611–618.CrossRefGoogle ScholarPubMed
3McDermott, FT, Cordner, SM, Tremayne, AB, the Consultative Committee on Road Traffic Fatalities in Victoria: Reproducibility of preventable death judgments and problem identification in 60 consecutive road trauma fatalities in Victoria, Australia. J Trauma 1997;43:831–839.CrossRefGoogle ScholarPubMed
4Cooper, DJ, McDermott, FT, Cordner, SM et al,: Quality assessment of the management of road traffic fatalities at a level 1 trauma centre compared to other hospitals in Victoria, Australia. J Trauma 1998;45:772–779.CrossRefGoogle Scholar
5McDermott, FT, Cordner, SM: Major trauma management deficiencies in Victoria and their national implications. Med J Aust 1999;170:248–250. Editorial.CrossRefGoogle ScholarPubMed
6Duke, GJ, Morley, PT, Cooper, DJ et al,: Management of severe trauma in intensive care units and surgical wards. Med J Aust 1999;170:416–419.CrossRefGoogle ScholarPubMed
7Rosenfeld, JV, McDermott, FT, Laidlaw, JD et al,: The preventability of death in road traffic fatalities with head injury in Victoria, Australia. J Clin Neurosci 2000;7:507–515.CrossRefGoogle ScholarPubMed
8McDermott, FT, Cordner, SM, Tremayne, AB, the Consultative Committee on Road Traffic Fatalities in Victoria: Consultative Committee on Road Traffic Fatalities: Trauma audit methodology. Aust N Z J Surg 2000;70:710–721.CrossRefGoogle ScholarPubMed
9McDermott, FT, Cordner, SM, Tremayne, AB, the Consultative Committee on Road Traffic Fatalities in Victoria: Road traffic fatalities in Victoria, Australia and changes to the trauma care system. Br J Surg 2001;88:1099–1104.CrossRefGoogle Scholar
10McDermott, FT, Rosenfeld, JV, Laidlaw, JD et al,: Evaluation of management of road trauma survivors with brain injury and neurological disability in Victoria. J Trauma 2004;56:137–149.CrossRefGoogle ScholarPubMed
11McDermott, FT, Cordner, SM, Tremayne, AB, the Consultative Committee on Road Traffic Fatalities in Victoria: Recommendations Advised by the Learned Colleges and Specialist Societies to Counter Problems Identified by the Consultative Committee in the Emergency and Clinical Management of Road Traffic Fatalities in Victoria. Report of the Consultative Committee on Road Traffic Fatalities in Victoria.Transport Accident Commission, June 1997.Google Scholar
12Human Services, Victoria: Review of Trauma and Emergency Services -Victoria 1999. Final Report of the Ministerial Taskforce on Trauma and Emergency Services and the Department Working Party on Emergency and Trauma Services, Victoria, 1999.Google Scholar
13American Association of Automotive Medicine, Committee on Injury Scaling: The Abbreviated Injury Scale-1985 Revision. Arlington Heights, Ill:The Association, 1990.Google Scholar
14Baker, S, O'Neil, B, Haddon, W et al,: A method for describing patients with multiple injuries and evaluating emergency care. J Trauma 1974;14:187–196.CrossRefGoogle ScholarPubMed
15Boyd, C., Tolson, M, Copes, W: Evaluating trauma care: The TRISS method. J Trauma 1987;27:370–378.CrossRefGoogle ScholarPubMed
16American College of Surgeons, Committee on Trauma: Resources for Optimal Care of the Injured Patient. Chicago: American College of Surgeons, 1990.Google Scholar
17Trauma Committee, Royal Australasian College of Surgeons: Early Management of Severe Trauma, Course Manual. Melbourne: Royal Australasian College of Surgeons, 1992.Google Scholar
18Ramenofsky, ML (ed): Advanced Trauma Life Support Course for Physicians, Instructor Manual. The American College of Surgeons, 1989.Google Scholar
19Ambulance Services, Victoria: Clinical Practice Guidelines. 9th Edition. Ambulance Service:Victoria, 1999.Google Scholar
20Roberts, I, Evans, P, Bunn, F et al,: Is the normalisation of blood pressure in bleeding trauma patients harmful? Lancet 2001;357:385–387.CrossRefGoogle ScholarPubMed
21Kwan, I, Bunn, F, Roberts, I, on behalf of the WHO Pre-Hospital Trauma Care Steering Committee: Timing and volume of fluid administration for patients with bleeding following trauma. In: The Cochrane Library, Volume 1, 2003.Google Scholar
22Winchell, RJ, Hoyt, DB: Endotracheal intubation in the field improves survival in patients with severe head injury. Arch Surg 1997;132:592–527.CrossRefGoogle ScholarPubMed
23Davis, DP, Hoyt, DB, Ochs, M et al,: The effect of paramedic rapid sequence intubation on outcome in patients with severe traumatic brain injury. J Trauma 2003;54:444–453.CrossRefGoogle ScholarPubMed
24McDermott, FT, Cordner, SM, Tremayne, AB: Evaluation of the Emergency and Clinical Management of Road Traffic Fatalities in Victoria (1992–1993). Report of the Consultative Committee on Road Traffic Fatalities in Victoria. Transport Accident Commission, 1994.Google Scholar
25McDermott, FT, Cordner, SM, Tremayne, AB: Evaluation of the Emergency and Clinical Management of Road Traffic Fatalities in Victoria (1993–1994). Report of the Consultative Committee on Road Traffic Fatalities in Victoria. Transport Accident Commission, 1995.Google Scholar
26McDermott, FT, Cordner, SM, Tremayne, AB: Evaluation of the Emergency and Clinical Management of Road Traffic Fatalities in Victoria (1997). Report of the Consultative Committee on Road Traffic Fatalities in Victoria. Transport Accident Commission, 1998.Google Scholar
27McDermott, FT, Cordner, SM, Tremayne, AB: Evaluation of the emergency and clinical management of road traffic fatalities in Victoria (1998). Report of the Consultative Committee on Road Traffic Fatalities in Victoria. Transport Accident Commission, 1999.Google Scholar
28Chesnut, R: Secondary brain insults after head injury: Clinical perspectives. New Horiz 1995;3:366–375.Google ScholarPubMed
29Chesnut, R, Marshall, L, Klauber, M et al. , The role of secondary brain injury in determining outcome from severe head injury. J Trauma 1993;34:216–222.CrossRefGoogle ScholarPubMed
30Wald, S, Shackford, S, Fenwick, J: The effect of secondary insults on mortality and long-term disability after severe head injury in a rural region without a trauma system. J Trauma 1993;34:377–381.CrossRefGoogle Scholar
31Trunkey, DD: Is ALS necessary for pre-hospital trauma care? J Trauma 1984; 24:86–87.CrossRefGoogle ScholarPubMed
32Hedges, JR, Sacco, WJ, Champion, HR: Analysis of pre-hospital care of blunt trauma. J Trauma 1982;22:989–993.CrossRefGoogle Scholar
33Sams, J, Kelly, AM: Use of an emergency sedation protocol to assist intubation in helicopter patient retrieval in Victoria. Emergency Medicine 1999; 11:84–89.CrossRefGoogle Scholar
34Bonatti, J, Goschl, O, Larcher, P et al,: Predictors of short-term survival after helicopter rescue. Resuscitation 1995;30:133–140.CrossRefGoogle ScholarPubMed
35Kidner, NL, Wardrope, J: Trauma audit. Care of the Critically Ill 1993;9(6).Google Scholar
36Nicholl, J: The role of helicopters in pre-hospital care. Prehospital Immediate Care 1997;1:182–190.Google Scholar
37Snooks, HA, Nicholl, JP, Brazier, JE, Lee-Mlanga, S: The cost and benefits of helicopter emergency ambulance services in England and Wales. J Public Health Med 1996;18:67–77.CrossRefGoogle ScholarPubMed
38Nicholl, J, Hughes, S, Dixon, S et al,: The costs and benefits of paramedic skills in pre-hospital trauma care. Health Technol Assess 1998;2:17.CrossRefGoogle ScholarPubMed
39Potter, D, Goldstein, G, Fund, S et al,: A controlled trial of pre-hospital advanced life support in trauma. Ann Emerg Med 1998;17:582–588.CrossRefGoogle Scholar
40Gatsoulis, N, Tzafestas, N, Damaskinos, A: Pre-hospital trauma deaths in a tourist region in Greece. Prehospital Immediate Care 2000;4:117–121.Google Scholar
41Sampalis, JS, Lavoie, A, Williams, J et al,: Impact of on-site care, prehospital times and the level of in-hospital care on survival in severely injured patients. J Trauma 1993;3:252–261.CrossRefGoogle Scholar