Evaluating the effectiveness of pre-hospital fibrinogen concentrate administration for major haemorrhage

Fibrinogen is a component of blood that is vital in the formation of blood clots, and low levels are often found in trauma patients who are bleeding. Low levels of fibrinogen cause problems with blood clotting and result in ongoing bleeding. Replacement fibrinogen has only been available in major hospitals which has been a problem given that the majority of trauma patients (most from the result of road accidents) treated by pre-hospital medical services are in rural and remote areas where this has not been available. Fibrinogen concentrate (FibC) is being introduced into Queensland’s pre-hospital and retrieval services to improve equity of access and facilitate early administration to patients that are critically bleeding. This study aims to evaluate the effectiveness of early FibC administration for bleeding trauma patients in the pre-hospital and retrieval setting and is the first study of its kind to do so. Should the study find a significant benefit of this early administration it will result in improved outcomes for such trauma patients, and has the potential to modify international medical practice in the management of bleeding trauma patients.

Research Capacity Building Grant – Retrieval Services Queensland

We propose to establish a 0.4FTE Research Coordinator role at RSQ to lead development of research capacity and culture within the agency, and provide support across our partner organisations – Lifeflight Retrieval Medicine (LRM) and the Royal Flying Doctor Service (RFDS) – QLD Section.

The Research Coordinator will provide a dedicated research focused role that will form part of the Research Leadership Team within RSQ, reporting to the RSQ Clinical Director for Research and Evaluation. They will be a key liaison with research partners and collaborators across the broader health sector, working closely with the Clinical Director.

It is anticipated that through the provision of dedicated research expertise and resourcing this position will greatly assist with the development of research capacity and culture within RSQ, and in turn RFDS and LRM. The proposed contribution of this role to the development of an RSQ Research Strategy will support identification of areas of research priority for the agency and provide a platform to foster collaborations with clinicians and researchers with shared interests, thereby building RSQ’s research network. Importantly, establishment of a Research Governance Framework will increase accessibility to RSQ data, staff and patients for the purpose of research, whilst providing a clear and risk managed process for overseeing all research activities, which is a vital function in supporting the agency’s growing research capacity.

Aeromedical Retrieval of people with Acute Behavioural Disturbance in Queensland – ELEVATE Study

The burden of mental illness on the Australian community and public health care system is substantial. (1) Every year in Queensland, approximately 300 people who present to a rural or remote ED location with acute behavioural disturbances (ABD) require aeromedical retrieval to an Authorised Mental Health Service (AMHS). ABD is “combined physical actions made by an individual which are in excess of those considered contextually appropriate and are judged to have the potential to result in significant harm to the individual themselves, other individuals or property” of rapid onset and a severe nature.(2)The transfer of people experiencing ABD is challenging due to difficulties in balancing patient rights and safety against that of the retrieval team. The aeromedical retrieval environment is restrictive, both in physical size and in relation to resource access, necessitating a heavy emphasis on risk-mitigation. Whilst research has established a safe approach to the sedation of people with ABD, other aspects of their retrieval remain lacking in evidence, and may contribute to suboptimal care and delayed access to specialist mental health services. This programme of research aims to explore those areas to ensure the management of people with ABD requiring aeromedical retrieval is optimal. Should changes in practice be required as a result, operating procedures and policies with Queensland's aeromedical network will occur.

Interhospital transfer of mTBI in rural and remote Queensland – can “low-value” transfers be avoided?

Globally, road traffic accidents are a leading cause of death in younger adults, particularly as a result of traumatic brain injury (TBI). Patients in rural and remote locations who have suspected TBI may need transfer for definitive investigation and management. Despite established guidelines on the need for CT imaging in minor TBI, we believe low-value transfers of this population group occur, placing an unnecessary burden on the patient, their family, and the healthcare system. This project aims to explore the interhospital transfer of people with mTBI, in an attempt to identify if and how such low-value care can be avoided, with resultant financial and personal cost savings to the individual and the healthcare system.

Applications of a novel neurosurgical service accessibility index to improve emergency care of people sustaining a road trauma-related traumatic brain injury in Queensland

Queensland’s dispersed population poses significant challenges to emergency trauma system design, requiring both road and aeromedical retrieval services, trauma outreach services and specialist transfer protocols for time critical injuries to maximise survival.

Road trauma is one of the main mechanisms causing traumatic brain injury (TBI). Pinpointing geographic regions with significant disadvantage for timely access to neurosurgical services is needed for targeting education, treatment and outreach services to Queensland regions most in need.

The Injury Treatment and Rehabilitation Accessibility Queensland Index (iTRAQI) is a tool being developed by this team, and piloted for TBI. iTRAQI maps aeromedical/road transport access routes and uses travel time to acute neurosurgical and rehabilitation services to rank accessibility among Queensland localities under realistic scenarios.

This project will map actual pathways to definitive neurosurgical care for moderate-to-severe road trauma-related TBI and compare them to modelled iTRAQI pathways using linked prehospital, emergency, hospitalisation and compensation data.