The National Trauma Research Institute was established in 2003 by partnership institutions Alfred Health and Monash University. The NTRI is located within the Alfred Medical Research and Education Precinct (AMREP) at The Alfred campus in Melbourne, Australia.
What is Trauma ? »
Trauma (physical injury) has contributed significantly to the rise of non-communicable disease. By 2020 trauma will represent the third greatest global disease burden, surpassed only by psychiatric and cardiovascular disease. The consequences of severe injury permeate all aspects of a person’s life including physical capacity, relationships, education and employment. These effects, in turn, have dramatic societal and economic impacts on local, national and global scales. Accessible, effective trauma care that results in reduced mortality and improved functional outcome is a current global imperative for this emerging burden of disease. However, this presents a challenge to traditional medical models.
In the 21st century, effective trauma care can be defined as comprising “an integrated, protocol-driven system of care which monitors and addresses prevention, notification, pre hospital care, hospital reception and resuscitation, surgical care, in-hospital care and rehabilitation”. The World Health Organisation advocates a spectrum of activities to decrease trauma morbidity and mortality. This encompasses surveillance and basic research through to prevention programs and effective trauma management strategies. Understandably much weight has been placed on preventive strategies (e.g. speed limits, seatbelts and alcohol breath-testing). However, there are also major gains to be made by improving the treatment of injured patients, particularly their initial management following arrival at hospital.
In particular, the initial hospital reception and resuscitation of severely injured patients is fraught with error. Patients are often physiologically unstable, with undiagnosed, life threatening injuries. Their presentation is unplanned occurring with minimal notification 24 hours per day, 7 days per week. Unsurprisingly, 55-91% of the reported errors that contribute to preventable deaths from injury occur during initial trauma reception and resuscitation. Improving this phase of care by the prompt identification and reduction of the errors that occur will result in significant reductions in morbidity and mortality.
The Victorian State Trauma System »
The Victorian State Trauma System is governed by a State Trauma Committee coordinated by the Department of Health and directly responsible to the Victorian Minister for Health. The Victorian State Trauma System plays an essential role in promotion, coordination, monitoring and implementation of the trauma system in a regional context. For more detailed information on the Victorian State Trauma System visit www.health.vic.gov.au/trauma.
Successful operation of an advanced Trauma System requires smooth integration of its complex components. This extends from the time of notification of ambulance services through every phase of care and includes integration of pre-hospital care providers and within and between city, rural and metropolitan hospitals. In Victoria an organisational structure with a central non-institutional focus to coordinate the efforts of all agencies involved in trauma care and to implement strategies for improving trauma services was introduced with inclusive representation from rural providers in both system planning and maintenance. As a result nearly 90% of all seriously injured patients in Victoria have their definitive care at a major trauma centre.
Evidence from mature systems in developed countries indicates that properly coordinated early rescue and retrieval systems together with appropriate early, in-hospital trauma management will prevent 15 - 30% of road crash deaths. The first hour after a crash is crucial to a person’s survival and limiting the extent of injury. Evidence from the United States, Europe and Australasia indicates that there are three major contributors to death following road trauma. The two key physical causes are airway obstruction and blood loss. These two factors can not only quickly lead to death, but can also make resuscitation more difficult and lead to longer term complications if allowed to persist for any length of time. The third major threat is delay to surgical treatment. This includes the provision of timely, adequate and appropriate emergency care at the accident site, expeditious delivery to hospital, and appropriate treatment on arrival and during subsequent hospitalisation. All stages of care provided need to be integrated.
The Alfred »
The Alfred was established in Melbourne, Australia in 1871 and is a Monash University teaching hospital. The Alfred is the busiest trauma centre in Australasia and has one of the largest and most advanced intensive care units in the region. As a major tertiary-referral hospital, it provides one of the most comprehensive ranges of specialist acute health and mental health services in Victoria. The Alfred is the designated surgical state-wide provider of major trauma, burns, heart and lung replacement and transplantation and hyperbaric medicine. In addition, the hospital offers statewide elective surgical services through The Alfred Centre, providing short-stay elective surgery, diagnostic procedures and other planned services for public hospital patients throughout Victoria (http://www.alfred.org.au).
The Alfred is a recognised world leader in trauma and critical care and has successfully developed and delivered international, interdisciplinary trauma training programs, linked to infrastructure capacity building and data monitoring. Specifically, The Alfred Trauma Service has assisted in the establishment of Emergency and Critical Care Medicine in India and Sri Lanka, served as a model for the establishment of the United Kingdom Trauma System and established the first Trauma Centres in Sri Lanka and Southern China. In addition, it has supported the training of several thousand medical and nursing staff in trauma reception and resuscitation in China (including Hong Kong), India, Myanmar, Singapore, Sri Lanka, The Philippines and Vietnam and facilitated the establishment of trauma registries to analyse care and measure the impact of interventions.
Monash University »
Monash University was established in Melbourne, Australia in 1958. With over 65,000 students, Monash University is the only Australian university to be active on four continents with campuses in South Africa, Italy and Malaysia. It has partnerships with 115 universities in 25 countries throughout the world and is ranked in the top one per cent of world universities.As a key partner of the NTRI, Monash University has a global reputation for research into accidents and injury, supporting trauma research and education as well as administering the Victorian State Trauma Outcome Registry (http://www.monash.edu).
The Central Clinical School (CCS) of the Faculty of Medicine, Nursing and Health Sciences is co-located with The Alfred, and is a centre for clinical and biomedical research and education, offering undergraduate and postgraduate study programs. The CCS is a core hub for translational research and medicine, covering an extensive array of subject areas. CCS’s research is highly collaborative, and the School is an integral part of the Alfred Medical Research and Education Precinct (AMREP), where world leaders partner in biomedical and clinical research.
According to the latest 2015-16 Times Higher Education World University Rankings, Monash University is now ranked 35 in the world in clinical and preclinical medicine and health. The rise in world ranking reflects its significant advancement in the five key performance areas of teaching, research, citations, industry and international engagement.