Vol 134 No 1532: 26 March 2021

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Issue Summary

Article

SUMMARY

Health impacts for New Zealand military personnel from the South African War of 1899–1902

Nick Wilson, Christine Clement, George Thomson, Glyn Harper

This analysis updated the war-attributable deaths to give a new New Zealand total of 239 war-attributable deaths (equivalent to the loss of 10,300 years of life for New Zealand military personnel). A new finding was also that over a third (39%) of personnel were estimated to have had some form of reported illness or injury. Much of the health burden could have probably been prevented if the personnel had been better prepared, properly equipped and appropriately supported with access to basic medical care.

Clinical Correspondence

SUMMARY

Keeping up with COVID: identification of New Zealand’s earliest known cluster of COVID-19 cases | OPEN ACCESS

Elizabeth Becker, Richard Vipond, Chris Mansell

In August 2020, a male in his 60s with flu-like symptoms was tested for COVID-19 in line with New Zealand’s testing guidelines at the time. The individual returned a weak positive result. Further investigation concluded the individual was an historical case of COVID-19 and was not considered infectious. His COVID-19 illness dated back to late February 2020, with the source of infection identified as an unwell family member who had travelled to New Zealand from the Lombardy region in Italy, approximately one week earlier. Further investigation confirmed historical infection for an additional five members of the man’s household also dating back to February 2020. The identification of this cluster of individuals with historical COVID-19 infection provides evidence that undetected local transmission of COVID-19 was occurring in the New Zealand community from late February 2020. The identification of this cluster supports the lockdown action taken in New Zealand in March and the benefits of following public health advice (stay home, wash your hands, cough and sneeze into your elbow) when you are unwell as effective strategies in reducing transmission of the virus.

Article

SUMMARY

Admission to hospital for injury during COVID-19 alert level restrictions | OPEN ACCESS

Grant Christey, Janet Amey, Neerja Singh, Bronwyn Denize, Alaina Campbell

The reduction in trauma hospital admissions during alert levels 4 and 3 was short lived, with a ‘rebound’ evident when restrictions eased across the Midland region. Hospital resources have been strained as this rebound coincided with a planned ‘catch up’ on healthcare delayed during the higher community restriction levels.

Article

SUMMARY

Rate and cost of representation in patients suffering from major trauma in Northland, New Zealand

Henry Witcomb Cahill, Matthew McGuinness, Olivia Monos, Christopher Harmston

This study aimed to gain an understating of how many people return to hospital following being discharged after suffering from a major trauma, as well as the reasons patients came back to hospital and the costs that is associated with these representations.

Viewpoint

SUMMARY

The Simpson-led health sector review: A failure to uphold te Tiriti o Waitangi

Heather Came, Jacquie Kidd, Tim McCreanor, Maria Baker, Trevor Simpson

The Health and Disability System Review (the Simpson Review) was an opportunity for transformation after the damning WAI 2575 Waitangi Tribunal report. The authors undertook a high-level review of the Simpson Review report analysing it against key elements of te Tiriti o Waitangi. This review was an opportunity to share power, commit to Māori health and embed anti-racism and structural mechanisms, such as the proposed Māori health authority to uphold te Tiriti o Waitangi. We concluded the Simpson Review did not take up these opportunities, but instead perpetuated further breaches of te Tiriti through minimising the advice of the Māori expert advisory group.

Article

SUMMARY

Use of tranexamic acid in trauma patients requiring massive transfusion protocol activation: a reassessment of prescribing behaviours in a major trauma centre in New Zealand

Nicholas G Chapman, Ella R V Nicholas

The use of tranexamic acid (TXA) in the early management of life-threatening bleeding has now been well established, but robust evidence also exists that it may do more harm than good if administered too late, particularly once three hours has elapsed from time of injury. Injury remains one of the most prolific killers of young New Zealanders, largely due to our unenviable road toll, with the South Island in particular having the highest incidence of major trauma in New Zealand, as well as greater distances that must be covered in order to reach hospital. In 2017, a study conducted at Christchurch Hospital found that TXA was underutilised in this cohort of severely injured patients requiring large volumes of transfused blood products, and just over a quarter received it after a delay of more than three hours. In order to ascertain whether utilisation rates had improved, we undertook a retrospective analysis of trauma patients who had required massive transfusion protocol (MTP) activation across a 26-month period, including in that cohort some of those injured in the March 2019 terror attack. During the period studied, 53 trauma patients requiring activation of the MTP were identified, and, of those for whom TXA should have been given, 90.9% received at least one dose, and, of all patients who received TXA, 16.7% received it within one hour of injury, 73.8% between one and three hours and 9.52% outside three hours. These results show that the utilisation of TXA is now more consistent with what is considered best practice, with figures now comparable to those of major trauma centres internationally. Persistent issues include the unrealised potential for much earlier use within the first hour, as has been achieved at centres where pre-hospital administration by ambulance services is the norm.

Article

SUMMARY

What a headache! Reviewing mild traumatic brain injury management in a new trauma service

Isaac Tranter-Entwistle, Melissa Evans, Simon Johns, Dominic Fleischer, Christopher Wakeman

Mild traumatic brain injury (mild TBI), often termed concussion in layman’s terms, is a common condition with significant consequences. At Christchurch Hospital, the current number of patients diagnosed, provided documented treatment advice and referred for follow-up is low. This suggests that current management needs improvement. A mild TBI protocol to standardise assessment, management and follow-up may facilitate this.

Article

SUMMARY

Audit of NZ COVID Tracer QR poster display and use in Dunedin | OPEN ACCESS

Lianne Parkin, Aqeeda Singh, Emily Seddon, Yvette Hall, Frances Bridgman, Kate Saunders, Madison Hutton, Oriwia Naera, Phillipa Rolleston, Raymond Siow, Stephanie Ewen

It is essential that the contacts of any newly diagnosed community cases of COVID-19 are rapidly identified, tested and quarantined/isolated, in order to prevent onward transmission of the virus and to minimise the need for lockdowns. The NZ COVID Tracer smartphone app and NZ COVID Tracer QR code posters were introduced to assist with rapid contact tracing in the community, but they are only useful if businesses and other venues display QR code posters appropriately and if visitors to those venues scan the posters. We assessed how well the NZ COVID Tracer QR code poster was displayed at randomly selected Dunedin cafes, restaurants, bars, churches and supermarkets and calculated the proportions of visitors to those venues who scanned the QR code poster. Some venues were displaying the QR code poster appropriately, but there was room for improvement at others. Disturbingly low proportions of visitors to the venues scanned the posters.

Editorial