Injury Treatment and Rehabilitation Accessibility Queensland Index (iTRAQI)

Queensland’s vast geography poses major challenges for timely emergency care for patients with TBI, particularly those injured on rural and remote roads. Distance, limited local services, and complex transport logistics often delay access to neurosurgical care.

To address these barriers, Dr Clinton Gibbsd a multi-agency team developed and piloted iTRAQI. This clinically informed tool uses real-world aeromedical and road travel times to visualise retrieval pathways, rank locality-based accessibility, and plan acute and rehabilitation services.

“Commonly used measures of remoteness such as ARIA+ and Modified Monash Model are based on road distances from population centres of specific sizes, but do not reflect healthcare services available in those towns, nor the time it takes to be transferred to access these interventions,” Dr Gibbs explained. “We felt none of the existing models accurately reflected the challenges faced by patients and the healthcare system in Queensland.”

Using linked prehospital, emergency and hospitalisation data, the team compared real patient journeys for moderate to severe TBI with iTRAQI’s modelled ideal pathways. This revealed significant discrepancies in time to care, even for patients who eventually reached definitive neurosurgical treatment.

Phase 2 involved a clinical audit of RSQ data to explore deviations from the model. Most deviations were due to clinical decision-making by the treating team, rather than limitations of the tool. This confirmed iTRAQI’s robustness while highlighting the complexity of trauma retrieval decisions.

“We know many factors that impact out-of-hospital and retrieval decisions in a state as large as ours,” Adam Rolley, Director of Patient Safety and Quality at QAS and Adjunct Senior Lecturer at QUT, outlined. “Developing the idealised model made us think about how to best quantify these complexities and reinforced the need for deep expertise in trauma systems operations.”

Findings were shared at a 2025 stakeholder workshop with clinicians, service planners, and policy representatives, who highlighted iTRAQI’s value in visualising system gaps. They also emphasised its potential to guide investment decisions on resource allocation, such as expanding telehealth, strengthening local services, or improving retrieval coverage.

There is strong support for adapting iTRAQI to other time-critical injuries, such as spinal cord trauma, major orthopaedic injuries, and burns, with ongoing collaboration across emergency care, rehabilitation, and policy sectors.

“iTRAQI provides the first look at access challenges to specialised neurosurgical care in Queensland,” Adam said. “Understanding these challenges from the moment of the Triple Zero (000) call, especially in regional and remote Queensland, offers useful insights for improving the quality of the Queensland trauma system.”

As Queensland’s first neurotrauma-specific rurality/access index, iTRAQI offers a unique, evidence-based tool that not only informs system planning but also strengthens collaboration, improves equity, and supports timely, life-saving care for patients across the state.