Written by Belinda Nolan, A/Trauma Program Manager
Trauma management across the Northern Territory (NT) offers unique challenges compared to the rest of Australia. With the population dispersed across a vast and wide area, multidisciplinary trauma education is vital to improve the outcomes of those impacted by trauma in the NT.
The Royal Darwin Hospital (RDH) is a Royal Australasian College of Surgeons (RACS) verified Level II Trauma Centre and the only major care provider for the Top End of the NT. With a large proportion of the population residing outside main urban centres, those living in rural and remote communities are a long distance from definitive health care.
The RDH Trauma Service is a multi-disciplinary clinical team that sees over 800 trauma admissions per year in a Territory with one of the highest rates of trauma in Australia. 2022 saw 167 major trauma patients admitted to the RDH Trauma Service, of those, 138 were transferred from rural or remote regions across the NT with median transfer time of 10 hours, a median flight distance of 818 km and driving distance of 2185km.
Long road and air travel times, and seasonal isolation during the Top End’s wet season result in extended pre-hospital and transfer times. Therefore it is critically important that rural and remote clinicians have a practical knowledge of trauma care in order to optimise outcomes for trauma patients. It is well known that management in the first few hours post-injury and while awaiting retrieval to a higher level of care is vitally important to reducing morbidity and mortality.
Improving trauma patient outcomes relies on a strong network of multi-disciplinary teams to have the practical knowledge of trauma care. Working with remote primary health clinics, regional hospitals and pre-hospital services is vital to support management of trauma patients in the first few hours while awaiting retrieval.
To support the development and maintenance of trauma care knowledge and skills in rural and remote areas, the RDH Trauma Service provides specialist outreach trauma education offering a comprehensive program of unique education courses delivered in Darwin and in remote communities. Each course is centred on safe and effective assessment and management of the trauma patient, and is contextualised to each locality's staffing, equipment and specific risks and challenges. These programs are interdisciplinary with doctors, nurses, paramedics, Aboriginal health practitioners and emergency service personnel invited to attend.
The RDH Trauma Management Committee, together with NT Health, developed trauma education for remote clinicians offering two courses: Remote Area Trauma Education (RATE), running since 2007 and Remote Pre-Hospital Trauma Disaster Course (RPHTDC), established in 2009. These courses collectively train over 140 clinicians per year.
RATE consists of a one day course with an emphasis on practical skills through small interactive groups and scenarios. RPHTDC is a two day course focusing on responding to road side incidents and managing disasters in remote settings. With motor vehicle crashes being the top mechanism for trauma injury, remote clinicians are the first to respond, hence supporting a high level of skill is vital to reduce mortality and morbidity. 2023 saw courses delivered across the Territory in locations including Groote Eylandt, Jabiru, and Tennant Creek.
As with the challenges surrounding trauma in the Top End, challenges exist to provide education as well. Taking often a small cohort of staff from their clinical roles, the remote nature of the education and travel required, together with measuring the impact of the education on patient outcomes. Despite these challenges there is a high demand for courses to be run each year, reflecting how important they are to improving overall care and outcomes for trauma patients across the NT.
Belinda Nolan
A/Trauma Program Manager & P.A.R.T.Y. Program Coordinator NT
Belinda is a Registered Nurse with over 16 years of experience, with a background working in critical care, retrieval, and trauma. Belinda is the Trauma Program Manager for the Royal Darwin Hospital Trauma Service and is responsible for the trauma education courses delivered across the Northern Territory (NT). Belinda is also the P.A.R.T.Y. Program coordinator for the NT, a community engagement program delivering trauma prevention and awareness education to students about the consequences of risk-taking behaviour. Belinda is a member of the AUSMAT Team and the lead of the AUSMAT Critical Care Working Group.