Symposium 2 - Trauma Management I

As we approach the end of the WHO Decade of Action for Road Safety there has been little evidence of a decline in road deaths globally.

Both Hong Kong and Australia exemplify the gross disparities in injury outcomes between high-income countries and low- and middle-income countries - that relate directly to the level of care received immediately post-crash and later in a health-care facility.

Trauma epidemiology and incidence varies between Hong Kong and Australia due to geographical and population differences and these will be highlighted.  However, the principles of Trauma Systems, trauma care and trauma outcomes are similar.

Perhaps it is time to consider Trauma Management (HK & Australia V East Asia)?

Hong Kong trauma system started from 1994. Before that, there is no interdisciplinary collaboration. This year, Professor Donald Trunkey, an US trauma expert advised on the development of trauma services through a multi-disciplinary approach. 24-hour trauma service has embarked the next year sequentially in all 17 HA acute hospitals. In the 2000 trauma review, Hong Kong trauma was reorganised, transfer of the seriously injured patients to the most appropriate facility hospitals was advised. Five major trauma centres were set up, QEH, PWH, QMH, TMH and PMH, based on their infrastructure, to balance the societal needs and quality of service. HA Central Committee on Trauma Service was found in 2004, constituting of the Trauma Directors and Trauma Nurses from the five major centres and representatives from different trauma related specialties. It is co-chaired by the Chief Manager of Infection, Emergency and Contingency of HA Head Office. This body provides strategic advice on service management, shares knowledge with commissioned training, monitors the effectiveness by annual report and set performance guidelines like the massive transfusion protocol and pelvic fracture management protocol for all the trauma centres to follow. Governance of every trauma centre is similar- with a Trauma Director with a Trauma nurse. The responsibility of Trauma Directors includes providing advice on clinical cases, education, research, inter-department coordination and guideline creation. Trauma Nurses would actively participate in every trauma case, and perform data collection, analysis and report generation. Central Committee Training Subcommittee also defines the priority of different training courses for the frontier and help in organization of funding. In Hong Kong, we have regular courses like Advanced Trauma Life Support (ATLS) at QMH for resuscitation in the Accident and Emergency Department and Advanced Surgical Trauma Course (ASTC) at QEH for operation theatre skills. We have yearly trauma case review and trauma symposium by different centres in turn to share trauma knowledge.