Major Trauma

How services coordinate to help a person suffering a major trauma event



Once we hear a patient is on their way, the system kicks in, either the ambos will triage the patient or we’ll do that once they're here.
Trauma Manager, Royal Melbourne hospital


Major Trauma is defined as:

admission to an intensive care unit for more than 24 hours, requiring a period of mechanical ventilation, serious injury to two or more body systems and an Injury Severity Score over 12, or, urgent surgery for intracranial, intrathoracic or intra-abdominal injury, or for fixation of pelvic or spinal fractures, or death after injury. Paediatric trauma refers to all children aged up to 15 years and 364 days.


Every year more than 2000 patients arrive at a Victorian hospital emergency ward.

Many will have suffered a major trauma from a transport accident, low or high fall, assault, self-injury, horse-related injury or burns.


Major Trauma incidents per 100,000 population

Source: Victorian State Trauma System and Registry Annual Report 2015-16

These 3 hospitals are designated as Major Trauma Services(MTS)

Major trauma patients will most likely go to one of Victoria's three designated major trauma hospitals: The Royal Children's, The Alfred or Royal Melbourne Hospital.

These designated hospitals are part of a statewide trauma system that specialises in major trauma care - care for head and spinal injuries, paediatrics, burns and more.

All of Victoria's main hospitals — from metropolitan to regional — work together in a coordinated way to give the best, most immediate care possible.


Phillip's personal story

A truck with a trailer laden with 120 pigs tips over on the Sunraysia Highway in the Northern Grampians Shires. SES, Police, ambulance and VicRoads attend the scene.

After the accident, Sharon's husband Phillip, the truck driver, is flown by air ambulance to the Alfred Hospital in Melbourne. It takes Sharon four hours to drive there.

Sharon: "The bolt gave way on the crate, so the whole thing took the prime mover over. Phillip went through the window and hit his head on the wall, and on the road. He had what they call diffuse axonal injury, so all of his brain was bleeding. He broke his neck, bruised his lungs, tore his ear. All upper body stuff."

Explore the interactive maps below to follow Phillip's story as it unfolded.





PHILLIP'S ACCIDENT CAUSES TRAUMATIC BRAIN INJURY

Glasgow Coma Scale

A coma scale scores a person's level of consciousness following a traumatic brain injury, and ranges from 3 to 15 - from no response to good response.

Phillip's coma-scale is 7-8 but increases to 9-10 when he hears Sharon's voice. A hopeful sign.



Psychological first aid

As you would expect, the impact of major trauma on families is dramatic and heart-wrenching. The effects are immediate.

Sharon: While waiting at Phillip's bedside, I lost all sense of time.

Trauma Manager at the Royal Children's Hospital, Helen Jowett, says this kind of reaction is expected. "We introduce the principles of psychological first-aid straight away. We say it's OK to feel like you’re going to be sick. It's alright that your heart's racing, that time is escaping. Those are normal reactions."

"It's not uncommon to remind people to eat, to go the toilet, to function again. We encourage them to focus on the practical things, perhaps something useful, as hard as that might be."

Sharon: It was my daughter's idea to create a journal and record the key moments. It would not only give us a kind of focus, but we could record Phillip's journey as well. Of course we wanted to be able to share it with him some day.



Phillip's journal

  • The truck after Phillip's accident. Because of drought, Phillip had taken a casual truck driving job. Sharon hears about an accident but has no idea it could be Phillip.

  • Journal: 'The photo we send out to let people know how you are'. Phillip's daughter starts a journal so that Phillip can read it once he is able to.

  • Phillip in the Intensive Care Unit at the Alfred hospital.

  • Journal: 'Mum sat down on the footstool and you put your legs up for a cuddle.' Image of Sharon and Phillip.

  • Phillip and his dog Jasper. Jasper learnt to prod Phillip to get him up regularly. People with an acquired brain injury spend a lot of time sleeping.

  • Journal: 'The boys come to visit.' Support from family and friends is important and helps improve recovery.

Victorian trauma services provide a range of services at a range of locations and coordinate to provide immediate care.

Please click on the map to locate Trauma services in Victoria


 

Uncertainty

Sharon: We knew Phillip's condition was serious, but no-one knew for certain what the end result might be.

I've been a nurse and in the health profession for 25 years, my daughter is a nurse too, and yet it still didn't seem to make any difference.

I was so overwhelmed by the activity and uncertainty.

For health professionals and the overall health system, helping to achieve the right supports for patients and families under these trying circumstances can be quite challenging.

Yet, this has become the mission of researchers at Monash University, and of course a major goal for hospitals and health services. What else can the health system do to ease suffering at this time? What are the issues? What improvements can be made? What insights might help patients and families in the meantime?


Major trauma researchers

Professor Gabbe and Dr Braaf are researchers from Monash University. They gather and interpret information to better understand types of injuries, hospital stays, recovery, rehab and long term impacts of major trauma.

Armed with quantitative and qualitative research, they provide advice to government, healthcare providers and the Transport Accident Commission on how best to make life easier for patients.

Professor Gabbe: The care that people receive and the support services that they receive become really very, very important once they leave the hospital.

We set up a beautiful trauma system to pick the patient up from wherever they've been injured and bring them to the right hospital to be treated. So we built a great trauma system to the point of hospital discharge.

It's the coordination of their care after they leave the hospital that becomes challenging in that environment too because [of] the different funders of all of those services.

Professor Gabbe's colleague, Dr Braaf, has interviewed many major trauma patients over the last three years. She offers insider advice to those currently recovering from major trauma, often in environments that are complex and overladen with technical language and jargon.

Her recommendation is to ensure you get information that you can understand, so you can use it to maximise your recovery.

Dr Sandy Braaf: Sometimes taking in and connecting information can be hard when a lot of different health professionals are involved in your care. However, certain actions can make it easier.

Be sure that you understand the information that you are given to manage your health. If it is not clear, ask for it to be said in a different way. Don’t stop asking until you are clear; get all the information you want to receive. Ensure that you know what you need to do to progress your recovery.

You can always ask health professionals to draw pictures, show you photographs, or just write notes in plain language to help you understand information. Ask for information to be written down the way it relates to you and your recovery.

Professor Belinda Gabbe and Dr Sandy Braaf

Remember, everyone's story is different. And no-one’s version will be simpler or easier.

No doubt, it won't be easy to ask medical staff questions either. Whether that's because of cultural reasons, trepidation, shyness, unable to muster enough strength and energy, or simply unable to take anything else on board.

Hospitals are already high-stress busy places, and coupled with your own stress you may feel too overwhelmed to ask questions. What's going on? Who is that doctor? What are they doing now? What does that mean? What will my future look like? What is the plan?

At the Royal Melbourne hospital

Over at the Royal Melbourne hospital, where they receive numerous major trauma patients a year, the trauma manager Kellie Gumm knows first-hand what could make a difference to patients and family members.

Apart from the comforting role, it is knowledge – helping patients and family understand as much as possible.

Kellie Gumm: Patients feedback all the time that they are confused and don’t know what’s going on.

Often in that acute period they are really unwell, there's a lot going on, they're on a lot of medications, they’re having a lot of tests. Family members are equally distressed. And I do believe they are told a lot of this information…but from my perspective of looking after these patients for 25 years, they just can't take it in.

On the other hand, people often don't ask enough questions. They just have blind faith. You should know that it's totally okay to ask questions. It's your body and it's your life. And if the patient can't ask those questions, the family can.

Write down all of the questions you may have. And make sure to get answers..

x-ray

Kellie Gumm suggests trying to step back and work out what is missing from your knowledge of the situation. Prepare to ask questions so you can fill in those gaps.

Kellie Gumm: Get a notebook. Family or friends should sit with a patient and write down all of the questions you may have. And make sure to get answers. Don't skimp now.

She says with such a busy environment it's often difficult for staff to stop and give additional information.

Kellie Gumm: But if a nurse is too busy at the time, she will make time to visit again later to answer questions.

Find out what the care plan is. Find out who your next contact is for any questions.

Of course, many of us may already feel empowered enough to ask questions. But we may not always be at our best – either from frustration or because of medical reasons.

Phillip's wife Sharon has some regret about the way she may have asked some questions.

Sharon: I was fiercely protective… My tone wasn’t great… My family was embarrassed….

Because I'm a nurse I was able to challenge medical decisions. Or at least make enquiries. My tone wasn't great. I was fiercely protective.

One time a nurse came in, she said, oh, good morning Mrs Tonkin, we’re just going to start Phillip on his Clexane. 'I said, no you're not.' Because I had visions of his head full of blood, and they're going to thin it even further.

But the staff didn't miss a beat, clearly explaining the rationale, and that he'd be quite safe.

They didn’t get cranky with me at any stage. In fact, my family got embarrassed. I was just being fiercely protective.

For some, the experience is so numbing they may not even be contemplating questions - only enduring the expected mental anguish. This is when social workers can help.



Listen to Phillip's story - from accident to recovery



Patients and their families can be assisted by hospital patient liaison officers or social workers.

Communicate with healthcare professionals to find out about the range of services and supports available to you.



Social workers can help

Kellie Gumm: Social workers can help patients deal with whatever the pressing issues are during their hospitalisation.

This could be around finances and accommodation and all the complex social family stuff that happens in trauma.

Social workers can also set up structure in the community if they need it ongoing.

Social workers can offer all kinds of advice, including suggestions about where to stay in the city if you need to stay overnight. They can even steer you in the right direction about compensation, insurance and finances. These can be very complicated.

Social workers, nurses and doctors may also begin asking their own questions.

Kellie Gumm: We need to know what are their living circumstances, where do they live, who do they live with? If they're young and they live with mates, are they going to go home to mum and dad? They might live in Melbourne but mum and dad are in the country. Essentially, what is the living situation?

Questions and answers may not always be in synch either.



Kellie Gumm: "Expect change. Then expect change again."

Because hospitals are such busy places and there may be a delay or overlap in information, there’s a chance that you may receive conflicting information. This is something that may be inevitable, and while it can be a source of frustration, change often means progress in care.

Kellie Gumm: Keeping up with what's going on with the patient is a real challenge. And I'm sure for the patients that's a real challenge as well, because they are often told you’re not going to have an operation for that.

Oh, hang on a minute, we've changed our mind. You are now. Or hang on, we can’t get you into theatre, we’ll leave you for a week. Or hang on, we are...

So I do think they get a lot of conflicting information. The key message is to expect change and possible delays in communication, or even communication crossfires. When conditions change, decisions have to be made accordingly.

Expect change. Then expect change again.

Finally, remember you're not on your own. The Victorian Department of Health and Human Services ensures that there is a range of services and support available for all Victorians.



Major trauma more information

  • Major trauma in Victoria

    Major trauma is a term that describes severe injury resulting in treatment in critical care (the emergency department or intensive care) at hospital. The main cause of major trauma are road accidents, low falls, criminal acts, self-injury, horse-related injury or burns.

    Read more
  • Emergency, crisis and support services

    Victoria's emergency, crisis and support services are there to help you in times of crisis, such as when a major trauma incident occurs.

    Read more
  • Metropolitan and regional trauma services

    Trauma services in metropolitan Melbourne and regional Victoria coordinate to provide adult and paediatric (for children) trauma care.

    Most trauma patients receive care at an appropriately designated trauma service.

    Read more
  • Major trauma discharge from hospital

    Being discharged is the process of leaving the hospital, and involves making decisions about your rehabilitation and recovery.

    Read more