Major trauma transfer in Western Australia

Background: The transfer of critically injured patients in a rural Australian setting presents a unique challenge to medical services due to the constraints of distance and time. The purpose of this study is to analyse which injuries are being transferred, how they occur, pretransfer intervention, transfer methods and transfer times. Methods: The Trauma Registry Database collected data prospectively on all major rural trauma cases attending the Royal Perth Hospital between August 1994 and January 2000. Patients were divided into rural and metropolitan groups on the basis of trauma location, and the latter group used as a control. Results: A total of 1275 major trauma patients were treated of which 566 (44%) were from rural areas. Driver road traffic trauma was the most common cause of injury throughout, although most prominent in rural areas (30%vs 18%). For rural patients, the Royal Flying Doctor Service was responsible for 440 (79%) of transfers of which 83% had a doctor and a nurse escort. The most commonly transferred injuries from rural areas were head injury (63%) and thoracic injury (55%). A total of 450 (93%) rural patients were transferred to Royal Perth Hospital within 24 h of trauma although the mean transfer time was over 9 h. Conclusions: This data produces a realistic framework of how major trauma in rural areas is treated in Western Australia. It highlights some areas of good practice, such as transfer methods and escorts, but also highlights problem areas such as transfer times and pretransfer intervention.