Head Injury Retrieval Trial (HIRT)

Sydney has twice the rate of severe disability in head injury survivors than cities such as London, Basel and Maribor in Slovenia. Unlike Sydney, these cities have a system under which a physician accesses a head-injured patient within 15 minutes of injury.

The Head Injury Retrieval Trial (HIRT) is a clinical trial which aims to demonstrate that the delivery of trauma physician management to accident scenes will improve outcomes for head injury patients.

An NRMA CareFlight team, led by Dr Alan Garner, spent seven years developing the most appropriate scientific methodology, gaining ethics committee approvals, obtaining financial backing, sourcing a suitable helicopter, recruiting and training crews, purchasing medical equipment and constructing base facilities for HIRT.

HIRT is being funded, at a cost of $11.2 million over three years, by NRMA Insurance. It is envisaged that this trial will reduce the financial and emotional burden that head injury imposes on injured people, their families and the community.

What is HIRT?

• HIRT is a randomised, controlled clinical trial being conducted by NRMA CareFlight.
• It is a world-first trial to compare two systems of pre-hospital care: standard ambulance/paramedic response versus helicopter/critical care doctor response.
• HIRT is part of NRMA Insurance's commitment to support programs which promote better recovery outcomes.

Why focus on head injuries?

• Severe head injury is the most common cause of death for people aged under 40, and a leading cause of disability in Australia: currently in NSW, one third of people with severe head injury die and one fifth are disabled.
• The brain is very sensitive to secondary insults. Early treatment by a skilled physician to avoid secondary insults is thought to be critical to the patient's recovery.
• Head injuries take a huge toll on families of patients and constitute an enormous cost to government, business and the community.

How does HIRT work?

• NRMA CareFlight identifies severe head injury patients by monitoring 000 calls.
• Patients are randomly assigned to either the current ambulance/paramedic system or NRMA CareFlight helicopter/specialist physician team.
• If the case is assigned to HIRT, a dedicated helicopter transports the NRMA CareFlight specialist physician team to the patient within 15 minutes of the 000 call.
• The HIRT team follows up on the progress, after six months, of those patients in both the treatment and standard care arms of the trial.
• Results are compared to determine whether providing head injury trauma treatment at the scene of an accident improves the recovery outcomes.
• The Trial will operate for three years during daylight hours.
• To achieve statistical validity, the Trial will involve about 510 unconscious patients, half of whom will be treated by HIRT and half of whom will be treated by standard care as currently provided by the Ambulance Service.

Study Review

• The Trial is overseen by a data and safety monitoring committee and operates with the assistance of the National Medical Health and Research Council of Australia Clinical Trials Centre at Sydney University.
• It has been approved by nine separate HR Ethics committees.

Potential Outcomes

• Delivery of a critical care doctor/paramedic team to severely head injured patients at the accident scene will decrease the death rate by a third and the severe disability rate by one half.
• If successful, the HIRT system could be extended to a 24-hour per day operation in Greater Sydney, with the possibility of establishing similar dedicated systems in other Australian states.