Dr Denis Allard – trauma surgeon

Exceptional Care, Every Patient, Every Time

Understanding Trauma

Trauma surgery became a new sub speciality in South Africa in 2008. This was an important step towards the creation of a national trauma system. Trauma surgery is the branch of Western medicine that deals with treating injuries caused by an external force on the human body.

Living in today’s world seems to become more and more challenging. At least that is how most of us feel. And on top of every other burden, South Africans are dealing daily with the plight of trauma.

Physical trauma that is. The injuries that are produced by road traffic accidents and pedestrian vehicle collisions; burns and falls; machinery accidents at work; blunt or penetrating violent trauma…. The list is long.

If there is one discipline in which South African doctors usually excel it must be trauma. Our urban hospitals are being visited by many international students. The new South Africa was still able to provide a mix of sound medical training and high patient numbers, especially over weekends. The high alcohol (and drug) usage plays a clear role in the high number of violent injuries and road accidents.

The way we, as a society, respond to trauma remains one clear example of how evolved and sophisticated we have become in 2022. The emergency medical response teams in the Western Cape belong to public and private companies. The paramedics are of a high standard and are most passionate about the care they give at the place of injury. But finding the best possible hospital for their injured trauma patients can remain challenging.

The unconscious patient with a low blood pressure, be it after a high-speed accident or a fall from a height, remains at the highest risk of dying … if the best possible care is not provided FAST. Bringing ‘the right patient to the right place in the right time’ (as the trauma adage goes) is easier said than done. Who is the right patient? Where is the right place? What is the right time?

Every injured person from a high-speed accident or a fall from several meters, be it from a scaffolding or a mountain cliff, is the ‘right patient’ that deserves an urban trauma centre. Every injured person with loss of consciousness, rapid heart rate and reduced circulation is that ‘right patient’ that deserves an urban trauma centre. Every wounded person soaked in blood is that ‘right’ patient that deserves an urban trauma centre.

Where is the right place? It is the nearest and most appropriate hospital, able to provide full emergency care. The Trauma Society of South Africa (TSSA) had established in 2011 (Guidelines for the assessment of trauma centres for South Africa, SAMJ, S.Afr.med.j.vol.101 n.3) what the different levels (1 to 4) of trauma hospital would look like. Not every hospital is able to handle the severely injured patient all of the time. Despite the very clear vision of the executive of the TSSA, building a reasonable trauma system in every province has remained challenging. Why is that so?

Establishing a top-level 1 or an urban trauma centre (level 2) can be challenging. Not only does a hospital have to have a trauma surgeon sub-specialist (and we are only 40 in South Africa) who will assure the immediate care and resuscitation of all trauma patients, but other associated specialists need to be available to support the injured patient. Emergency doctors, general surgeons, anaesthetists, orthopaedic specialists, and neurosurgeons able to provide spinal surgery… these are all supporting specialists that assure the best holistic trauma care. Not to forget the expert nursing staff and wound care nurses, physiotherapists and dietitians. And all of these professionals need to be available 24/7/365!

The ‘right time’ is in no doubt the fastest time possible. Re-establishing oxygen to all the cells of the body is what keeps the effects of trauma injuries at a minimum. Helping to open the airway, removing the obstacles to lung expansion, stopping the bleeding and providing again blood flow to all the organs and tissues while protecting the spinal cord and preventing the patient from becoming cold…. These are the A-B-C-D-E’s of the well-established Advanced Trauma Life Support (ATLS) assessment that all trauma providers are using. This method of approaching trauma was brought over from the US back in 1992 by young passionate South African trauma providers who are now retired Professors mostly. We, the young generation, owe it to our patients to continue the legacy of best trauma care in SA.