New Zealand Trauma Crisis

The Trauma Committee of the Royal Australasian College of Surgeons has warned that both Australia’s and New Zealand’s hospital trauma services would not cope with the effects of a large-scale medical disaster because of a serious lack in government funding and planning on both sides of the Tasman.

“If a catastrophe like the Bali bombing happened in New Zealand it would severely test the medical systems as the appropriate levels of trauma care are not in place to respond effectively and that should be of major concern to all New Zealanders, “said Associate Professor Peter Danne, Chairman of the RACS Trauma Committee.

“The systems in New Zealand and Australia are deficient and cannot provide the level of care which we would expect in our societies.

“It is just not good enough that our trauma services do not even approach international benchmarks. Both Governments must put some money towards improving trauma services, as we may not have long to get it right, ”said A/Prof Danne.

A/Prof Danne chaired a Forum on Monday night on Australasias’s Medical Responses to Terrorism, which was attended by Mr Ian Civil, Director of Trauma at Auckland Hospital and Chairman of the RACS’ New Zealand Trauma Committee, surgeons from Darwin and other trauma centres around Australia and New Zealand. Representatives from the US Airforce, the Indonesia Medical Response Team and the Australian Defence Force Response Team to Bali also contributed.

The Forum, which was called in response to the Bali bombing, examined just how well Australasian trauma services would cope with a medical disaster and what needs to be done to make sure they can in the future.

“The medical management of even one severely injured patient with multiple injuries is recognised as being the most difficult management process of all medical conditions. “What we need is a pre planned system for the care, teamwork and triage system which gets the patient to the right hospital, at the right time and with the appropriate resources and staff for that patient. It must have the capacity to rapidly respond to a large number of patients as in the Bali situation.

“The golden hour is well recognised after injury where a patient’s bleeding and hypoxic problems may result in death without appropriate care, we only have a short time to save patient’s lives.

“Analysis of the United States responses to terrorism show that it is critically important that there is an Integrated Trauma System established in regions where terrorism is a possibility. In New Zealand and Australia integrated trauma systems are still in their infancy and are deficient,” A/Prof Danne said.

Studies done in Victoria show that up to four years ago, up to 35 per cent of patients dying from ordinary traumatic incident had potentially preventable deaths and 41 per cent of those survivors, who had serious complications, had potentially preventable complications.

Currently the average potentially preventable death rate, where it has been measured in Australian trauma services, is 30 per cent. In New Zealand it is unknown but unlikely to be much different. International benchmarks show that this potentially preventable death rate can be well under 10 per cent and closer to 4 per cent.

Members of the Trauma Committee called on the New Zealand Government to recognise that there is a problem with New Zealand trauma services and to be more aware that the risk of terrorism will test our medical system even further.

“Immediate Government action is needed to find out what and where the problems are, what systems are in place for assessing the ability of individual hospitals and regions to cope with the management of trauma victims and to start establishing Integrated Trauma Systems. “The most critical resource for successful Integrated Trauma Systems are human resources – appropriately trained doctors, nurses and paramedics, linked together in a planned integrated trauma system. Unlike Australia where the Defence Force has some capacity to mount an immediate medical response, the New Zealand Defence Force does not and this only adds to the concern.

Professor Danne said that there are three major phases to medical responses to major disasters, which are the immediate response at the scene, on site treatment and triage (a sorting of patients by severity), followed by the retrieval of the patient back to an established medical system.

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