Neurological injuries in South Australia: the influence of distance on management and outcome.

It has been shown that in at least two Australian states (New South Wales and South Australia), there is a disproportionately high incidence of lethal neurological injuries in country areas. To determine whether any of this increased rural mortality results from geographical remoteness from specialized hospital services, we have studied prospectively a consecutive series of 153 patients with head injuries (140) or spinal injuries (13), who were transferred to Adelaide, South Australia from country centres during a six month period. Distance appeared to be an occasional cause of delay in instituting expert primary treatment. Of 13 deaths, three resulted from potentially remediable causes (intracranial bleeding, airway obstruction), and in two others difficulties in early supportive care may have contributed to death. First aid sometimes had to be administered by lay persons, and appeared to have been occasionally inadequate. Undesirable delay in transfer from accident site to country hospital was recorded in a few cases; in some of these, private transport was used. Distance was an important cause of delay in transferring patients to Adelaide, since 77% of patients had to travel in excess of 50 km. Thirty patients were brought to Adelaide by medical retrieval teams. These teams, which are centrally co-ordinated, have been useful in extending to country areas the specialized techniques of emergency intensive care and less frequently of operative neurosurgery.