A trauma elective in Sydney: How does it compare to London?

Rhys Rhidian

Tuesday, March 29th, 2011

Dr. Rhys Rhidian
Foundations Year 1, Urology
Queens Hospital, Burton
United Kingdom

Rhys is currently working as a junior doctor at Queens Hospital, Burton-on-Trent, UK. He studied medicine at Barts and the London School of Medicine and Dentistry, London, UK. He went to Liverpool Hospital, Sydney, in his final year of medical school, for an elective in trauma. He is planning on pursuing a career in emergency medicine, and hopes to return to Sydney at some point to gain experience working in this field.

“Will you see shark bites?” was a question I was asked a few times by other medical students when I told them I was doing an elective in trauma at Liverpool Hospital, Sydney. While I promptly replied this was unlikely (especially as Liverpool is a lot further from the coast than I initially realised), I was secretly hoping I would see something exciting. Although there were no shark bites or kangaroo assaults, I did see some very interesting cases while over on your side of the world, such as a patient who managed to sever his radial artery with an angle grinder and a traumatic amputation of a patient’s arm by an industrial machine.

Trauma as a speciality

One of the first things I noticed was that the set-up of the trauma department was different from in the United Kingdom (UK). At home, trauma as a speciality is generally combined with orthopaedics, and there are few surgeons specialising in trauma as a whole. This helped to explain the initial email I received back from my elective supervisor, who said that this was an elective in trauma, not emergency medicine, which made me worry I would be doing orthopaedics for six weeks! The orthopaedic and trauma surgeons in the UK manage the musculoskeletal aspect of the poly-trauma patient’s care, and other surgeons are called upon as necessary, for example vascular surgeons. Here there are specific ‘trauma’ surgeons who specialise after completing general surgical training, and are responsible for the overall surgical management of the trauma patient. This includes following them up on the wards, in the intensive care unit (ICU) and clinic as necessary. This was something I had not come across before. Indeed, trauma surgery as a single speciality does not currently exist in the UK, nor is there a training program. There are, however, some centres that provide more specialist trauma care, such as the Royal London Hospital.

Mechanism of injury

In many ways, the type of trauma I saw in Sydney was very similar to that of London. The majority of the trauma I have seen in both cities is as a result of motor vehicle collisions, which was not surprising. [1] Another common mechanism was falls, with increasingly elderly populations with many co-morbidities contributing to this problem in developed countries. [2] This is now being complicated when the fall results in a head injury, with many of these…