A day in the life of a trauma surgeon

Professor Russell Gruen is an internationally regarded general-and-trauma surgeon, currently working at The Alfred Hospital in Melbourne. He is also Professor of Surgery and Public Health at Monash University, Director of the National Trauma Research Institute (NTRI) and leads the Centre for Excellence in Traumatic Brain Injury Research for the Victorian Transport Accident Commission. In his words, Professor Gruen gives GEreports a glimpse of a day in the trauma unit at The Alfred. He tells how technology is getting even better at taking over some of the critical tasks. And he explains how his team’s work brings Victoria’s best-in-the-business trauma care to treat the critically injured all around Australia, and the world. 

For the past decade, this has been my office: the trauma centre at Melbourne’s Alfred Hospital. It is the busiest trauma centre in Australia, where more than 6,000 injured people are hospitalised each year, 1,200 of whom have severe, potentially life-threatening injuries. There are four identical trauma bays, all running at once. Over 2,500 times each year my SMS dings to notify me, as a member of the trauma team, of the imminent arrival of another patient.

This is not like any other type of medicine. Most patients come to doctors and hospitals able to tell about what’s wrong, what they’ve had in the past, what medicines they take and what they’re allergic to. There’s usually time to arrange a few tests, negotiate a plan, and let the patient think about what they want, and perhaps get a second opinion.

In trauma there’s none of this. Rather than an obvious or easily diagnosed problem, we’re confronted with patients with any of hundreds of possible injuries, the only initial clues being how the injury happened, what you can see externally, such as the bruise on the head, the deformed limb, clothes wet with blood or a distended abdomen, and the other telltale signs: blood pressure too low, not enough circulating oxygen, unconscious.

Often there is also time pressure to diagnosing what’s wrong, and fixing it, before the patient literally bleeds to death.

Professor Russell Gruen describes this as his “office”: the trauma centre at Melbourne’s Alfred Hospital. Image courtesy of Alfred Health. 

The Victorian State Trauma System is the one of the best trauma systems in the world. Introduced in 2001, it’s been a statewide commitment to improving the care for the seriously injured, and has involved triage and transport protocols, strengthening ambulance services and designating and strengthening a small number of high-performing trauma centres—ultimately to get patients to the care they need in the shortest amount of time.

We’re now working with all 27 trauma centres across Australia, 6 in New Zealand, and supporting our Asian colleagues to learn these lessons, supporting better systems, upskilling our people, and utilising technological solutions. We’re doing this through a variety of techniques, including using innovative data capabilities built into the Australian Trauma Registry and the Australian Trauma Quality Improvement Program.

We’re putting technological solutions to better use. We aim to achieve that across the country, and ultimately throughout the world. GE is a major partner in this endeavour with the whole team, in our ambulances, our ERs, our radiology depts, our operating theatres and our ICUs. GE is there as part of resuscitation, identification, operation and rehabilitation.

Technology in healthcare is the most exciting thing. We’ve already got highly trained, highly skilled people. We’ve now also got a system of care in Victoria which has transformed the landscape and the outcomes. So what’s the next great medical echelon of discovery? While we may not know exactly what it is, for sure it’s technology-based.

So what’s the next great medical echelon of discovery? For sure it’s technology-based.

While we may not be able to do much about the initial injury, we can intervene in time to prevent the second hit that often occurs—ongoing bleeding with compression of the brain, for example, or a harmful exaggerated response by the body to the injury. We need to get the technology and interventions to the patients in a short enough time that they don’t have their own processes turning against themselves. So that means bringing things into the ambulance or chopper: ways of stopping bleeding; new ways of protecting the brain; drug treatments to minimise inflammation, and diagnostics to give better insights about what is going on.

Another part of the goal is to make these not so much doctor-driven things as things that an ambulance officer or even a relatively untrained person can use. If you look at the evolution of the defibrillator: it’s gone from being a specialist device in cardiac-care units in hospitals, to more widely used in hospitals, to ambulances and now on the wall in offices and shopping centres and it does most of the work itself. There’s no human decision-making apart from grabbing it and putting it on the chest.

The future is also around technology that takes it from being in a few hospitals where only a few specialists can use it out to the masses. From a global perspective, 90 per cent of the seriously injured people are injured in lower and middle-income countries and they don’t have access to the kind of care patients receive in trauma centres like Victoria’s. So to address the global burden of injury, we have to be developing technology. We can’t rely on trauma specialists—we are too few. We need to invest in smart technologies that can be applied by less trained people.

Where we’re at with a lot of medical technologies, is accepting that there are limitations to humans and their decision-making, and seeing what we can hand over to technology that actually is better. And then also making simple life-saving technology available to all.

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