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.

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.

REPRIEVE: Rural/Remote Emergency Pain Relief Investigation and Evaluation

Injuries confer a substantial burden on ambulance services. Ensuring optimal pain management for injured patients in the out-of-hospital setting is imperative, and even more so for those living in rural/remote areas, where transportation times to hospital may be longer. There is evidence for the potential for improvement in pain relief in the out-of-hospital setting. Inadequate pain relief has lasting negative physiological and psychological implications and decreases overall quality of life. While there is little research focusing specifically on management of pain incurred through trauma in regional/rural/remote environments, there are several reasons that pain management may be suboptimal in rural/remote trauma patients, compared with patients in major cities. This research aims to describe pre-hospital pain management for trauma patients in regional/rural/remote Queensland and to compare this with pain management provided in major cities. Secondarily, we aim to identify and describe perceived barriers/facilitators of optimal pain management among paramedics in rural/remote areas, compared with those in major cities. This study will incorporate three components:
1) Data from the Queensland Ambulance Service(QAS) will be used to describe current pain management practices for those sustaining injury;
2) Queensland paramedics will be surveyed to gather information on pain management and whether/how this differs across major cities/rural/remote settings;
3) Interviews with rural and remote paramedics will be conducted about their experiences and perceptions in managing pain in trauma patients

Ultimately our goal is to identify explicit opportunities to mitigate barriers and enhance enablers to optimise pain management for those experiencing trauma in rural/ remote settings.

Evaluation of older patients with minor blunt head trauma to identify those who do not have clinically important Traumatic Brain Injury and can be safely managed without cranial Computed Tomography

Older patients with minor head injury routinely get a head scan in emergency departments due to the risk of a brain bleed. Recent studies have suggested that some of these patients may not need a head scan. However, doctors do not currently have an accurate method to identify those patients who do not need a scan.

This research aims to identify a subgroup of older patients with minor head injury who do not have a brain bleed and can be safely managed without a head scan. As there are no known Australian studies in this area, this innovative project addresses a common problem in a vulnerable group of patients with several potential benefits.

The study will inform emergency doctors about the feasibility of larger Australian studies to develop a reliable and accurate method to identify older patients who do not have a brain bleed and do not need a head scan. Such a method could benefit patients by reducing transfer from rural and remote communities to bigger hospitals for a head scan, reducing waiting times in emergency departments and reducing exposure to radiation. Such a method could also have significant cost savings to the Australian healthcare system by reducing costs associated with patient transfers, head scans and prolonged emergency department wait times.

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.