Westmead Hospital’s trauma service admits around 1600 patients every year, with about one third of these patients being moderately to severely injured.
Road incidents account for one third of all cases coming through the doors and into the arms of the hospital’s trauma specialists.
Dr Jeremy Hsu is the director of trauma at Westmead.
The last 40 years of trauma at Westmead was discussed in depth by Professor Stephen Deane during Hospital Week.
“Trauma’s one of those things where you can make a difference very quickly,” he said.
“Trauma is physical injury to body tissues … we manage trauma patients in a very systematic and very protocoled way, which actually fits with the way I think.”
Dr Hsu underwent advanced training in general surgery at Westmead from 2007, and after further specialised trauma training in the United States, returned to Sydney to take up the directorship at Westmead in 2012.
At the core of Westmead’s approach to treating trauma, is the concept of decision nodes, or choosing the right pathway for each patient.
“The basic approach to trauma is addressing the most life threatening injuries and correcting them in a specific order,” Dr Hsu said.
“At Westmead we have taken it one step further – we have developed a set of pathways and algorithms that help with all of those decision nodes.”
Westmead is one of the major trauma centres in New South Wales, servicing Western Sydney and the western parts of the state.
“We’re lucky overall in that we don’t see a lot of gunshot wounds; the majority of patients that we see are as the result of falls and motor vehicle crashes, motorcycle crashes, cyclists and pedestrians,” Dr Hsu said.
“But we do get stabbings and we do get the occasional gunshot wound.”
According to the Centre for Road Safety, every year since 2008 there have been between 6000 and 7000 serious injuries from road accidents in New South Wales.
At Westmead, apart from the large number of road trauma cases coming in, about 40 per cent of trauma admissions are due to falls. At least a 1/3 of these trauma patients have multiple injuries.
“These are really sick people – so you need a structured, formalised approach to make sure that patients are treated properly,” Dr Hsu said.
Westmead was one of the first public hospitals to roll out a smartphone app to help trauma teams streamline their treatment and care.
“It’s more like a checklist because what we are trying to get through is that trauma patients should be treated in a standardised fashion,” he said.
Dr Hsu said standardising treatment was important in an environment where multiple staff and specialists from a range of medical disciplines are all working together on the same trauma patient.
“Trauma patients require the coordination of multiple teams,” he said.
“The patient will go from emergency, to radiology, to the operating room, to the ICU, back to the operating room.
“The most challenging thing is making sure that you’ve got control of everyone, to keep the patient at the centre of it.
“It means that the patients are getting exactly the same approach and exactly the same care and therefore getting the ideal outcome.”
Dr Hsu is proud of the culture Westmead has developed towards trauma care.
Apart from the advances such as the structured approach to trauma and the Westmead trauma app, Dr Hsu sees several other milestones as shaping the course of modern trauma methodology at Westmead.
Signficant trauma developments at Westmead over the last 30 years include the establishment of a dedicated trauma team, the development of aeromedical retrieval services such as Careflight, and the mountain of knowledge being built up through Westmead’s trauma registry, which has tracked the treatment of every trauma case for the past three decades.
“The thing that I find most rewarding is that this hospital has its roots in trauma care,” he said.
“What I’m really pleased to see is that it feels like everyone is proud of the fact that we deal with trauma and we do it well and the patients get good care.”