Road traffic fatalities in Victoria, Australia and changes to the trauma care system

Background: The aim was to identify organizational and clinical errors in t he management of road traffic fatalities and to use this information to imp rove Victoria's trauma care system. Methods: A multidisciplinary committee evaluated the complete ambulance, ho spital and autopsy records of 559 consecutive road traffic fatalities, who were alive on arrival of ambulance services, in five substantial time perio ds between 1992 and 1998. Patients who survived more than 30 days were excl uded. Errors or inadequacies in each phase of management, including those c ontributing to death, were identified and an assessment was made of the pot ential preventability of death. Results: Findings between 1992 and 1998 were similar. In 1998, 1672 problem s were identified in 110 deaths with 1024 (61 per cent) contributing to dea th. Eight hundred and forty-two (50 per cent) of the total problems occurre d in the emergency department. There were frequent problems in initial pati ent reception and medical consultation, resuscitation, investigation and as sessment (especially of the abdomen and head), and in transfer to the opera ting theatre or to a higher-level hospital. Victoria's combined preventable and potentially preventable death rate has been unchanged between 1992 and 1998 (34-38 per cent). Conclusion: The problems identified led to a Ministerial Taskforce on Traum a and Emergency Services in Victoria as a consequence of which a new trauma system is now being implemented.