Section 1. Setting the Scene

The Scale of the Trauma Problem

Trauma is a leading cause of death and disability in Australia and is a major public health problem. Trauma results in more years of potential life lost to 65 years of age than any other cause. It represents a significant proportion of hospital, emergency care and rehabilitation costs. The Taskforce considers that the capacity to expertly manage time-critical major trauma, which requires rapid system response and collaboration of multiple disciplines, is a positive indicator of the wider emergency system's capacity to manage other groups of time-critical patients.

In Victoria, injury is the leading cause of death in people aged one to 44 years. During childhood, injury accounts for approximately 50 per cent of all deaths. In adolescents and young adults, it accounts for 75 per cent of total deaths (NISU, 1998).

Trauma deaths are only a small proportion of the total trauma cohort. Recognition of the number of deaths from trauma does not account for the full scale of the problem. In Victoria, for every death from injury there are 31 hospital admissions and 144 emergency department visits (Health and Community Services, 1994) .

The cost of treatment of trauma is significant. For the financial year 1991 - 92, the inpatient hospital costs in Victoria attributable to injury were $145.9 million. This represents just over 10 per cent of total inpatient costs to the State (Health and Community Services, 1994).

This cost does not include the total costs to the individual and the community that result from trauma. It also does not include economic costs to the State, such as costs from legal expenses, rehabilitation, emergency services and associated insurance costs.

Causes of Trauma

The most common single cause of trauma in Victoria is motor vehicle crashes (Figure 1.1). Road trauma is still the leading cause of death among people aged under 45 years. In the age group of 15 to 25 years, it accounts for about 40 per cent
of all deaths (National Road Traffic Advisory Council (NRTAC) 1993).

Figure 1.1: Proportion of Injury-Related Deaths by Cause, Victoria 1996

Type of Injury	% of Deaths	% of Deaths
Unintentional Injuries Transport Poisoning Falls Fires/Burns/Scalds Drowning Other Unintentional	63.8	30.9 2.9 16.8 2.2 3.3 7.7
Intentional Suicide Violence TOTAL	36.2     100	33.4 2.8 100

Source: Department of Human Services, Public Health and Development Branch, Victorian Burden of
Disease Study
The distribution of trauma patients in Victoria is related to population and geographic factors. While most trauma in Victoria occurs in metropolitan Melbourne (Appendix 3), there is a higher incidence in rural areas (Figure 1.2). In particular, there is a significantly increased rate of trauma from motor vehicle accidents. This relates to the increased loss of life years in rural towns and remote rural areas when compared to metropolitan Melbourne (Figure 1.3). This trend is more marked in males than in females and more marked for traffic accidents than other causes.

Figure 1.2: Metropolitan/Rural Trauma Distribution, Victoria 1997 - 98 (n=1550)

Includes public separations identified from the VIMD with discharge ICD9 CM codes 800-959.9 and either an admission to ICU or death.

Excluding: 840-848, 905-925, 930-939, 958-959, and patients 65 years of age or older whose sole trauma code is an isolated hip fracture (820-820.9)

Source: Department of Human Services, Public Health and Development Branch, Victorian Burden of Disease Study

This increased rural risk is related to a combination of factors including increased kilometres travelled, more travel at high speed and a greater exposure to roads of a lower standard for any one individual. Alcohol consumption, age of vehicles and seat-belt wearing have also been identified as contributing to higher rural and remote death rates related to motor vehicles (AIHW, 1996). Issues regarding the access to high level emergency medical care also become a factor in the management of this increased rural rate of trauma.

Figure 1.3: Years of Life Lost by Injury Cause per 1,000 Population, Victoria 1996