Putland Mark, Noonan Michael, Olaussen Alexander, Cameron Peter, Fitzgerald Mark
Emergency Department, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.
National Trauma Research Institute, The Alfred Hospital, Melbourne, Victoria, Australia.
Emerg Med Australas. 2018 Dec;30(6):834-842. doi: 10.1111/1742-6723.13135. Epub 2018 Jul 28.
Regionalised civilian trauma systems improve patient outcomes, but may deskill clinicians outside major trauma services (MTSs). We aimed to characterise experience and confidence in trauma management among emergency physicians working in MTS to those working elsewhere.
Emergency physicians working within the Victorian State Trauma System were surveyed about their pre- and post-fellowship training experience, their estimated hours per fortnight in different centres, the frequency of performance/supervision of critical emergency skills and their confidence in a range of trauma skills.
The 138 respondents analysed represented 33% of active Victorian FACEMs. The cohort were mostly males (69.6%), younger than 50 (75.4%) and were generally (69.6%) six or more years post-fellowship. FACEMs working in a MTS were more likely to have been a trauma registrar prior to fellowship (13.3% vs 3.7%, P = 0.046). MTS clinicians performed more, supervised more and were more confident in trauma team leading, traumatic airway management and rapid infusion catheter and multi-access catheters. Confidence in trauma team leading was only associated with exposure to performance or supervision of trauma team leading. Performance of trauma team leading was more common in clinicians at a MTS (odds ratio 3.19, 95% CI 1.00-10.20, P = 0.05).
Exposure to major trauma is associated with time spent working in a MTS and exposure is associated with confidence. A mature inclusive trauma system must ensure clinicians across the system gain the experience or training to provide trauma care that will result in similar outcomes for patients regardless of initial presenting hospital.
区域化的民用创伤系统可改善患者预后，但可能会降低主要创伤服务机构（MTS）以外临床医生的技能水平。我们旨在描述在MTS工作的急诊医生与在其他地方工作的急诊医生在创伤管理方面的经验和信心。
对在维多利亚州创伤系统内工作的急诊医生进行调查，内容包括他们专科培训前后的经历、估计每两周在不同中心工作的时长、关键急救技能的执行/监督频率以及他们对一系列创伤技能的信心。
分析的138名受访者占维多利亚州在职急诊医学专科医师（FACEM）的33%。该队列大多为男性（69.6%），年龄小于50岁（75.4%），且一般（69.6%）在专科培训后有六年或更长时间。在MTS工作的FACEM在专科培训前更有可能曾是创伤专科住院医师（13.3%对3.7%，P = 0.046）。MTS的临床医生在创伤团队领导、创伤气道管理以及快速输液导管和多通道导管方面执行更多操作、监督更多且更有信心。对创伤团队领导的信心仅与接触创伤团队领导的执行或监督有关。创伤团队领导的执行在MTS的临床医生中更为常见（优势比3.19，95%置信区间1.00 - 10.20，P = 0.05）。
接触重大创伤与在MTS工作的时间有关，且接触与信心有关。一个成熟的包容性创伤系统必须确保整个系统的临床医生获得经验或培训，以提供创伤护理，从而无论患者最初就诊的医院如何，都能为患者带来相似的预后。
