A longitudinal study of one hundred consecutive admissions to the Royal Adelaide Hospital for carbon monoxide poisoning was conducted from 1986 to 1989. Twenty-five patients left hospital with persistent symptoms and signs of this poisoning. Five subsequently recovered. Twenty-four other patients, who were well when they left hospital, did not attend for a review one month after discharge. Extensive neuropsychiatric testing at this time showed 32% (24 of 76) had obvious sequelae of their exposure. Overall, the frequency of neuropsychiatric sequelae in the patients who only received oxygen at atmospheric pressure was 63% (N = 8) on discharge and 6 7% (N = 6) on one month follow-up. The frequency of sequelae among those who were given one hyperbaric oxygen treatment only was 46% (N = 24) on discharge and 50% (N = 20) on one month follow-up. In contrast, the frequency of sequelae in patients who had two or more hyperbaric oxygen treatments was only 13% (N = 68) on discharge (P< 0.005) and 18% (N = 50) on follow-up (P < 0.005). The frequency of sequelae was also significantly greater if hyperbaric oxygen was delayed (P < 0.05). No markers of severe poisoning could be identified.

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LMOs in remote locations may consider immediate drainage of deteriorating traumatic ICH. Adequate support from a distant major trauma centre can help achieve acceptable outcomes. Effective communications are vital. The Royal Australasian College of Surgeons and Neurosurgical Society of Australasia guidelines based on the Early Management of Severe Trauma protocols can assist LMOs in making the decision to undertake emergency craniotomy.

Synopsis In the years from to 1995, Adelaide‐based mobile intensive care teams transported 4443 critically ill patients from rural areas in South Australia and adjacent States to tertiary‐level hospitals in Adelaide. The SA Ambulance Service undertook communications, support staffing and deployment of transport. Average radial distances in 819 road missions were 71 km, in 808 helicopter missions 122 km, and in 2777 fixed‐wing aircraft missions 398 km. The largest groups of patients were neonates (23%) and those with trauma (25%). Rural hospitals made 96% of the requests for intensive care transport; 4% came from ambulance or other emergency service crews at accident locations. Emergency surgical or operative obstetrical procedures were performed on 2.7% of patients before transport. One hundred and thirteen patients (2.5%) died during resuscitation or transport, with one death deemed to be preventable.

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