How did you become interested in trauma medicine?
When I was a first-year medical student at the University of Adelaide I was driving home through the city around midnight on a Saturday night and I stopped at the pie cart to get something to eat. There was a guy lying on the road just near the pie cart and there was a ring of people standing around him just looking on. I felt I should stop and help because I was a medical student but I had no idea what to do. Then the ambulance arrived and I felt quite sheepish because I didn’t know how to help. So the next day I collared one of my mates and we went to St John’s House in the city and signed up for a first aid course and they were looking for volunteer medical students to work on the ambulances. So that started me doing ambulance stuff in the mid-’70s, which I did for 15 years. The road toll then was 370-something as opposed to under 100 this year so I went to multiple fatalities before I even graduated medicine.
I started doing surgical training but decided after a year or so that it wasn’t for me. I wanted to do trauma surgery and there didn’t seem to be a place for one in Adelaide at the time from what I could see. That’s when I decided I wanted to do the retrieval work. I was quite interested in that pre-hospital, rescue, trauma type of thing so I decided to do intensive care because emergency medicine as a specialty didn’t exist back then. Before I did intensive care I did anaesthetics because everyone I knew who did it had two specialist qualifications.
I graduated in 1980 and finished my second specialist qualification in 1989 and got a job as a consultant in the RAH Intensive Care Unit in 1990.
They established the Trauma Service at the Royal Adelaide in 1995 so I was the first and still the only director.
How did you become involved with trauma rescue?
There are a lot of medical people in South Australia involved with the military and after I did my specialist training I could see I was going to have a hard time avoiding being dragged into that as well. My father was a pilot in the Second World War and so were two of my uncles. I am named after one who didn’t come back. I was doing some work with the flying doctor and I quite liked the flying side of things so I signed up for the Air Force Reserve in 1987. There had been nothing really since Vietnam in terms of deployments and there didn’t look like there was anything on the horizon but then the Gulf war came out of nowhere. I got a phone call on Christmas Eve 1990 to work on a hospital ship. So off I went to the Gulf War, I spent time on a hospital ship and an aircraft carrier and since then I’ve done about 12 deployments of one sort or another including both the 2002 and 2005 Bali Bombings, the 2004 Boxing Day Tsunami, East Timor and the Samoan Tsunami in 2009.
What are some of the most confronting international situations you’ve faced?
The first Gulf War was quite threatening – it might seem pretty benign now – but we had briefings about all sorts of risks ranging from the potential for nuclear to chemical to biological type things and that was pretty extreme. The East Timor stuff was intense, I had an episode which involved going to a mass murder site where they dug up nine hessian bags with the remains of four people in them and I struggled a bit with that mainly because the kids of the people were there as we were digging them up. Probably the hardest thing I’ve done was Banda Aceh. I was rung and asked to go to Thailand to pick up injured Australians after the 2004 Tsunami and we were refuelling in Darwin when someone came over and said ‘I need you two guys to get on that Hercules over there and go to Medan in Sumatra’. We were the first foreign aircraft to land in Banda after the tsunami. We drove around and saw hundreds and hundreds of bodies. We negotiated to use a couple of buildings that we’d seen on the way around, one of which was an abandoned hospital. There was a six-day period there when I got separated from all my gear and just had what I was standing up in and it was very, very busy and very intense. I worked with some really good people and we did some really good stuff. They were probably six of the hardest days of my life but six of the most rewarding.
Why did you decide to do an MBA at the University of Adelaide?
I went back to uni a couple of times. I went to Otago University in New Zealand and did a Post Graduate Diploma in Aviation Medicine and then I wrote a new course for them in Aeromedical Evacuation and I taught on that for a while.
In 2006 I was thinking that I was doing more and more management stuff but I had never had any management training so I signed up to do a subject of the MBA at the University of Adelaide, which was fundamentals of leadership. I actually never had any real intentions of doing the whole MBA, I just wanted to do a few subjects to keep myself up to speed. I thought I knew a bit about leadership but I actually learnt an enormous amount not only about the science of leadership and management but I learnt a lot about myself and that was really quite important. So I really got a lot out of that first subject, in fact I got so enthusiastic I thought I would do two subjects next semester.
I signed up for accounting and marketing and I loved it so I then just worked my way through the subjects until I was finished.
I learnt a lot and I became interested in things that weren’t medical management and it opened doors for me to do some work in other areas. It also helped me understand things that I hadn’t previously had training in like writing business cases and financial stuff. I was asked to join a few not-for-profit boards so it definitely helped me with that. I was then elected to the Super SA board and was asked to join the Motor Accident Commission board and now I’m the chair of that.
How has trauma medicine changed since the unit started in 1995?
When I began there was me and a half-time secretary. There were no specialist emergency physicians in the hospital. Gradually we built up a group of people and the two elements I wanted to work up were the resuscitation area and the other was the surgical management of trauma. At that stage there weren’t many surgeons in the hospital who would have listed trauma in their top 10 areas of interest. It was sort of seen as something you did as a senior registrar and then you moved on to something else. Now we have at least five surgeons who are quite passionate about trauma and it’s pretty well self-sufficient. We also have 15-odd emergency medicine specialists and a fully accredited department. My main role now is teaching, supervising and looking after our registrars –I still go and take over a trauma case if there’s two or three at a time.
We see about two thirds of the major trauma cases in the state – about 2500 a year – ranging from car accidents, shootings, stabbings, falls from heights, assaults, drownings, burns etc. We have a team system in place with 10 members.
What are some of the challenges facing trauma units in Australia?
I’m very keen on prevention now and trying to work out how we can do better, particularly on the roads. If we look at injuries, there’s some stuff that’s come out of the military treatment of patients which we now use in the civilian world in the same way as there’s civilian techniques they now use in the military world.
The whole aeromedical retrieval stuff came about from military experiences in Korea and Vietnam.
How will the new RAH be set up from a trauma treatment perspective?
Generally speaking, I think the new RAH is a wonderful thing. There’s no doubt that if you build a hospital from scratch you can do stuff that you can’t achieve on an existing site. I think a hospital is for patients, not for doctors. If I’m a patient, I want to get good medical care, that’s a given, but you also want to be comfortable and feel safe and they are all things that are very good about the new hospital. Clearly also when you are building a hospital you are building it with the current specs and the latest state-of-the-art equipment. From a trauma point of view we’ve got more resuscitation rooms, they are bigger, they are well set up. It will be much better able to cope than we are now and it will be a very good facility. One of the challenges with trauma is that you want everything next to everything. When the patient comes into the resuscitation room you want to be able to get a cat scan and you want to be able to get them into theatre and you want to be able to get them to ICU quickly but there’s only so many things you can have next to each other so there’s always compromises and the hospital needs to be set up for all the patients, not just my patients.
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