Trauma medicine: Skills and opportunities
Emergency physicians with trauma skills have always been highly valued in the emergency department (ED), largely due to the high proportion of people with trauma-related injuries presenting for care. Figures show that patients with traumatic injuries presenting to Australian EDs represent 26 per cent of all ATS 1 and 15 per cent of all ATS 2 presentations,respectively[1].
ACEM is looking to further build and enhance opportunities for ED physicians to develop their trauma managements skills and expertise. Programs and openings in hospitals across Aotearoa New Zealand and Australia are creating pathways for growing numbers of FACEMs to specialise, study, research and teach trauma medicine both within and outside of the ED.
ACEM is heavily involved in providing and expanding opportunities and resources for members and trainees to gain training and experience in trauma medicine. FACEM Dr Fran Williamson is Deputy Director of the Royal Brisbane and Women’s Hospital. Dr Williamson is also Education Co-Lead at the Jamieson Trauma Institute, as well as Chair of ACEM’s Trauma Emergency Medicine Network.
“‘Our focus is trying to build the trauma community within the College. It’s the best way to help the next generation of emergency physicians feel confident and comfortable in treating trauma patients.’”
‘Our focus is trying to build the trauma community within the College,’ Dr Williamson said. ‘It's the best way to help the next generation of emergency physicians feel confident and comfortable in treating trauma patients by having a focus on education and training resources, getting out there for networking events, and creating a community in which we can share research ideas and other quality improvement projects.’
‘[The College is] trying to provide a supportive network so that it doesn't matter where you are in Australia and Aotearoa New Zealand, there are people who have the same interest and the same passions in trauma care that you do.’
Dr Williamson said her trauma focus provided many opportunities for her to make a difference both at a national level and across her local community. As a committee member with the Queensland Trauma Clinical Network (QTCN), she works with multi-disciplinary clinicians from across Queensland who have an interest or a background in trauma. The QTCN develops statewide guidelines, looks at statewide trauma policy and oversees the education program.
“‘[The College is] trying to provide a supportive network so that it doesn’t matter where you are in Australia and Aotearoa New Zealand, there are people who have the same interest and the same passions in trauma care that you do.’ ”
‘In conjunction with the Jamieson Trauma Institute [Metro North Health] and our Clinical Skills Development Service (CSDS), we have a program called Queensland Trauma Education,’ Dr Williamson said.
‘One part is an online repository of educational resources. It also has a face-to-face course where we teach a multidisciplinary cohort of people - doctors, nurses, paramedics, and allied health workers - about trauma and trauma care. We deliver that locally here at our CSDS, but more recently are going to far-flung places in Queensland, like Thursday Island in the Torres Strait. We recently went to Kingaroy and Stanthorpe and we're about to go to Longreach and Emerald, so we can tailor the education program to the local team, make sure what we are teaching is very Queensland focused, to make it locally relevant.’
Trauma experiences
Dr Jennifer Jamieson
Opportunities for FACEMs to learn and develop trauma experience extend beyond Australia and Aotearoa New Zealand. Just ask FACEM Dr Jennifer Jamieson, Deputy Director of the Trauma Service at Royal Hobart Hospital.
‘Early in my training I took a year off to work with Médecins Sans Frontières (MSF) in Afghanistan at a dedicated trauma hospital in Kunduz, northern Afghanistan,’ Dr Jamieson said.
‘It had been left very dilapidated and run down because of decades of conflict. It wasn't just the physical hospital, but the health system processes and guidelines and the sort of internal architecture of how we would run a trauma system, especially in a remote post-conflict setting.
‘I learned the joy of working in multidisciplinary teams. Trauma is, and always will be, a team sport. It required the integration of multiple personnel - medical, nursing, allied health, engineers, architects, logisticians to rebuild the hospital. My time there with MSF was incredibly rewarding.’
Associate Professor Joseph Mathew
Career opportunities
Learning skills and developing experience in trauma medicine is opening new career opportunities for emergency physicians across Aotearoa New Zealand and Australia. FACEM Associate Professor Joseph Mathew is the Acting Director of Trauma Services at The Alfred Hospital. Assoc Prof. Mathew said that emergency physicians are now often taking the lead in managing trauma.
‘Critical care physicians, especially emergency physicians, are leading from the front, all the way to the discharge of the patient,’ Assoc Prof. Mathew said.
‘Trauma has now become a new career pathway within emergency medicine. Emergency physicians are part of the front end of resuscitation, but some emergency physicians trained in trauma care [are involved in] inpatient admission, managing the inpatient perioperative care up in the ward, all the way to discharge, which is not a model that has existed before.’
The increasing call for additional emergency physicians with trauma experience has led to demand for trauma specialists to teach the next generation. Assoc Prof. Mathew has university teaching credentials and said that demand for trauma training is skyrocketing.
“‘Trauma has now become the new career pathway within emergency medicine.’”
‘We run a trauma masterclass for emergency physicians to understand perioperative care and also give extra training to them for critical life-saving skills,’ Assoc Prof Mathew said.
‘We run a procedures course, which is accredited by ACEM. We run around nine courses [across Australia], four in Europe and now we have just started in the US, specifically catering to life, limb and sight-saving procedures and interventions. We started that course in 2017 and it's very popular across the world now.’
Hospital-based opportunities for emergency physicians to develop trauma experience are also growing outside of the ED. FACEM Dr Matthew Oliver, co-director of the Department of Trauma and Staff Specialist in the ED at Royal Prince Alfred Hospital, said that the skills possessed by trauma specialists leave them well positioned in other areas of care.
Dr Matthew Oliver
‘Historically trauma has been under the umbrella of surgery. What we find now is with trauma patients, most of them don't need acute surgery,’ Dr Oliver said.
‘Even major trauma patients can have complex medical needs. The classic is the elderly trauma patient who sustains a ground-level fall and is incredibly frail. Those patients might not need an acute general surgeon or a trauma surgeon, but they do need a fairly good, well-rounded approach to their care that is going to encompass aspects of geriatric medicine, but also trauma medicine.
‘Having that good approach from an emergency physician, that big-picture perspective of how to manage the complex injuries and also their medical need - such as their atrial fibrillation, pneumonia or UTI causing them to fall, and managing their frailty and preventing delirium, and multi-modal pain management - is super important,’ Dr Oliver said.
‘The emergency physician really has a great position there, because we are truly a generalist and involved in many departments within the hospital. In trauma we’re involved in all aspects of patient care, from injury prevention and pre-hospital care all the way through to the acute hospital, then finally through to the recovery aspect. As an emergency physician we are used to working with staff from many different disciplines.’
“‘The emergency physician really has a great position there, because we are truly a generalist and involved in many departments within the hospital. ”
Opportunities at home
Dr Jamieson, who is also the current chair of ACEM’s Global Emergency Care Committee, has continued to pursue opportunities to develop trauma medicine skills and experience as well as training opportunities. In particular, she has focused her attention on the equity of trauma care across Tasmania and has secured grants to establish the P.A.R.T.Y. program (Prevention of Alcohol and Risk-related Trauma in Youth) for secondary school students. She has also implemented Trauma Team Training for clinicians across the state.
‘Afghanistan was one end of the spectrum. In recent years, it's been a real joy to introduce a trauma service to Tasmania as well,’ Dr Jamieson said. ‘A lot of the last four years of my work has been establishing the Tasmanian Trauma Service and working with the state to try to work out how we address the inequity of trauma care across Tasmania.’
“That makes such a huge difference to people and their daily lives. It’s awesome.’
Join the Trauma Emergency Medicine Network – a community of practice for emergency medicine professionals
[1] J. Crilly, D. Bartlett, I Sladdin, R. Pellatt , J. T. Young, W. Ham, L. Porter : ‘Patient profile and outcomes of traumatic injury: The impact of mode of arrival to the emergency department’; Collegian, Volume 29, Issue 5, October 2022, Pages 720-727
