The “golden hour” of trauma care is irrelevant in rural
areas. We studied the effect of distance and remoteness
on major trauma
patients transferred by the Royal Flying Doctor Service
and remote Western Australia.
The Royal Flying Doctor Service retrieval
and Trauma Registry databases were linked for the period of July 1, 1997, to June 30, 2006. Major trauma
was defined as Injury Severity Score (ISS) >15. Remoteness
was quantified using the Accessibility/Remoteness
Index of Australia (ARIA) classes: inner regional, outer regional, remote, and very remote. The primary outcome was death.
Among 1328 major trauma
transfers to Perth, mean age was 34.2 years ± 18.3 years (range, 0–87 years) and 979 (73.7%) were male. Over half were motor vehicle crashes. Mean transfer time was 11.6 hours (95% confidence interval [CI], 11.2–12.1). The median ISS was 25 (interquartile range [IQR], 18–29), and there were no differences within the ARIA classes for cause and injury patterns. After adjusting for ISS, age, and time, the risk of death increases as remoteness
increases: outer regional odds ratio (OR), 2.25 (95% CI, 0.58–8.79); remote, 4.03 (95% CI 1.04–15.62); and very remote, 4.69 (95% CI, 1.23–17.84). Risk increases by 87% for each 1,000 km (OR, 1.87; 95% CI, 1.007–3.48; p
= 0.05) flown. Despite long retrieval
times, there were no deaths in flight.
There is an excess of a fourfold increase in the risk of major trauma
death in patients transferred to Perth from remote and very remote Western Australia. Remoteness
, as measured by the ARIA, is more important than distance, in the risk of death.