No abstract

Objective: To determine if emergency personnel, either ambulance or hospital based, can estimate the volume of external blood loss accurately enough to be of potential clinical use in guiding fluid resuscitation. Methods: A total of 61 ambulance and 35 hospital personnel viewed nine scenarios consisting of volumes of blood (100 mL, 400 mL and 700 mL) spilt onto three surfaces — carpet, vinyl and a clothed manikin. They were asked to estimate the blood loss in each case. Results: Estimates of volumes of blood loss on all surfaces were generally inaccurate. Both ambulance and hospital groups were comparable in this regard. Hospital personnel had higher mean estimates than those of ambulance personnel. Of particular clinical relevance were the findings that blood loss on carpet was underestimated and small volumes on a clothed manikin were overestimated. Conclusion: External blood loss estimation by ambulance and hospital personnel is generally too inaccurate to be of clinical use.

Background: Injury is the leading cause of childhood death and disability in Australia. Prehospital emergency services in New South Wales (NSW) are provided by NSW Ambulance. The incidence, pre-hospital care provided and outcomes of children suffering major injury in NSW has not previously been described.Methods: This retrospective study was conducted between July 2015 and September 2016 and included children < 16 years with an injury severity score (ISS) > 9, or requiring intensive care admission, or deceased following injury and treated in NSW. Children were identified through the three NSW Paediatric Trauma Centres, the NSW Trauma Registry, NSW Medical Retrieval Registry ( AirMaestro , Avinet, Australia).Results: There were 359 majorly injured children treated by NSW-based emergency service providers, the majority were male (73.3%) with a mean (SD) age of 8.0 (5.2) years. The median (IQR) injury severity score (ISS) for those transported via NSW emergency medical services was 10 (9-17), with almost half (44.1%) treated prehospital having an ISS > 12. The most common documented interventions were intravenous access (44.1%) and oxygen therapy (39.6%). Intubation and chest decompression were recorded in 15.3% and 3.1% of cases respectively. The calculated median (IQR) transport charges for NSW Emergency Services

Background: There is known variability in the quality of care delivered to injured children. Identifying where care improvement can be made is critical. This study aimed to review paediatric trauma cases across the most populous Australian State to identify factors contributing to clinical incidents. Methods: Medical records from three New South Wales Paediatric Trauma Centres were reviewed for children <16 years requiring intensive care; with an injury severity score of 9, or who died following injury between July 2015 and September 2016. Records were peer-reviewed by nurse surveyors who identified cases that might not meet the expected standard of care or where the child died following the injury. A multidisciplinary panel conducted the peer-review using a major trauma peer-review tool. Records were reviewed independently, then discussed to establish consensus. Results: A total 535 records were reviewed and 41 cases were peer-reviewed. The median (IQR) age was 7 (2-12) years, the median ISS was 25 (IQR 16-30). The peer-review identified a combination of clinical (85%), systems (51%) and communication (12%) problems that contributed to difficulties in care delivery. In 85% of records, staff actions were identified to contribute to events; with medical task failure the most frequently identified cause (89%). Conclusion:The peer-review of paediatric trauma cases assisted in the identification of contributing factors to clinical incidents in trauma care resulting in 26 recommendations for change. The prioritisation and implementation of these recommendations, alongside a uniform State-wide trauma case review process with consistent criteria (definitions), performance indicators, monitoring and reporting would facilitate improvement in health service delivery to children sustaining severe injury.