DOCSLIB.ORG

Position Paper

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Position Paper Neurosurgical Society of Australasia Inc The Management of Acute Neurotrauma in Rural and Remote Locations A set of guidelines for the care of head and spinal injuries FORWARD These guidelines were first published in 1992 and revised in 2000 and 2009. They are intended to assist medical practitioners responsible for the initial management of patients with neurotrauma in places remote from specialised services. The outcome from severe head and spinal injury is often determined by the adequacy of initial care from the scene of injury through to definitive care. Since the first edition most rural practitioners have undertaken Early Management of Severe Trauma (EMST) training. This and the rural surgeons training scheme of the Royal Australasian College of Surgeons have given rural surgeons the skills to manage acute neurotrauma. These guidelines are compatible with the EMST approach and terminology. Many larger rural hospitals have access to CT scanning and teleradiology which are of great assistance in sharing the responsibility of neurotrauma management with the central neurosurgical services. All rural hospitals have access to retrieval services. The guidelines are to be seen as part of a trauma management system beginning at the accident site and continuing through to definitive care at a regional or state trauma centre. EDITORIAL COMMITTEE The Neurosurgical Society of Australasia gratefully acknowledges the contributions of the following individuals who have contributed to this publication. Peter Reilly (Chair) Neurosurgeon Adelaide Eric Guazzo Neurosurgeon Townsville Glenn McCulloch Neurosurgeon Adelaide Francis Miller General Surgeon Wangaratta Jeffrey Rosenfeld Neurosurgeon Melbourne Marianne Vonau Neurosurgeon Brisbane Third Edition: 2009 Published by: Neurosurgical Society of Australasia Inc College of Surgeons’ Gardens 250 - 290 Spring Street EAST MELBOURNE VIC 3002 © Neurosurgical Society of Australasia Inc This work is copyright. Apart from any use as permitted under the Copyright Act 1968, no part may be reproduced by any process without written permission from the Neurosurgical Society of Australasia Inc. Requests and enquiries concerning production should be directed to the Executive Director, Neurosurgical Society of Australasia at the address shown above. TABLE OF CONTENTS EPIDEMIOLOGY ............................................................................................................................................................ 4 Incidence ...................................................................................................................................................................... 4 Factors in the Rural Environment ............................................................................................................................... 4 Factors Adversely Influencing Outcome (Death and Disability) ................................................................................. 4 Avoidable Causes of Death or Disability ..................................................................................................................... 4 EVIDENCE OF THE MECHANISM OF HEAD INJURY .......................................................................................... 4 Site of Injury ................................................................................................................................................................. 4 Type of Injury ............................................................................................................................................................... 5 Pathology of Injury ...................................................................................................................................................... 5 Secondary Insults ......................................................................................................................................................... 5 PREHOSPITAL CARE ................................................................................................................................................... 6 Position of the Unconscious Patient ............................................................................................................................ 6 Tracheal Intubation ..................................................................................................................................................... 6 Spinal Injury ................................................................................................................................................................ 6 PRIMARY HOSPITAL INITIAL MANGEMENT ....................................................................................................... 7 Stages of Initial Management ...................................................................................................................................... 7 STAGE 1: PRIMARY SURVEY .................................................................................................................................... 7 Primary Survey Considerations ................................................................................................................................... 7 STAGE 2: RESUSCITATION ........................................................................................................................................ 7 Resuscitation Considerations ....................................................................................................................................... 7 Important Notes ........................................................................................................................................................... 8 STAGE 3: SECONDARY SURVEY .............................................................................................................................. 8 Secondary Survey Considerations ............................................................................................................................... 8 Specific Neurosurgical Assessment .............................................................................................................................. 8 Using the Glasgow Coma Scale (GCS) ........................................................................................................................ 9 Glasgow Coma Score ................................................................................................................................................... 9 CT Head Scan ............................................................................................................................................................ 10 Skull Xray Indicators ................................................................................................................................................. 11 STAGE 4: DEFINITIVE CARE .................................................................................................................................... 12 Definitive Care Considerations ................................................................................................................................. 12 Criteria for Admission to Hospital ............................................................................................................................. 12 Criteria for Neurosurgical Consultation ................................................................................................................... 13 Indications for Transfer to a Neurosurgical Service ................................................................................................. 13 What the neurosurgeon will need to know ................................................................................................................. 13 Transport and Retrieval ............................................................................................................................................. 13 Management options for a deteriorating patient with suspected intracranial haemorrhage..................................... 13 EMERGENCY SURGICAL TREATMENT ............................................................................................................... 14 The Side of Surgery .................................................................................................................................................... 14 Technique ................................................................................................................................................................... 16 Surgery for an acute subdural haematoma ................................................................................................................ 17 Instrumentation .......................................................................................................................................................... 17 COMA MANAGEMENT– NEUROLOGICAL DETERIORATION ....................................................................... 18 Intubation and Ventilation ......................................................................................................................................... 18 Intravenous Fluids and Electrolytes .......................................................................................................................... 19 Active Treatment of Raised Intracranial Pressure ....................................................................................................
Load more

Recommended publications
  • Screening for Latent Tuberculous Infection in People Living with HIV Infection in Auckland, New Zealand
    INT J TUBERC LUNG DIS 21(9):1008–1012 Q 2017 The Union http://dx.doi.org/10.5588/jtld.17.0103 Screening for latent tuberculous infection in people living with HIV infection in Auckland, New Zealand N. Gow, S. Briggs, M. Nisbet Department of Infectious Diseases, Auckland City Hospital, Auckland, New Zealand SUMMARY SETTING: New Zealand, which has a low incidence of RESULTS: Of the 752 patients from the initial cohort, tuberculosis (TB), has historically taken a risk-based 416 (55%) had documentation of LTBI screening, which approach to screening for latent tuberculous infection was positive in 74 (10%): 19/461 (4%) low-risk and 55/ (LTBI) in adult people living with the human immuno- 291 (19%) high-risk patients. LTBI treatment was deficiency virus infection (PLHIV). received in 13 low-risk and 44 high-risk patients. Of OBJECTIVE: To evaluate LTBI screening, treatment and 73 patients in the second cohort, 68 (93%) were outcomes in an adult PLHIV population. screened. DESIGN: This was a retrospective clinical record review CONCLUSION: LTBI screening was incomplete in our of an initial cohort of adult PLHIV attending the clinic, but improved between 2011 and 2014. A Auckland City Hospital HIV clinic in 2011, and a significant number of patients with LTBI did not second cohort of adult PLHIV newly attending the clinic originate from a high TB incidence country. in 2014. We analysed high-risk (born in or acquiring KEY WORDS: PLHIV; high-income countries; screen- HIV in a high TB incidence country) and low-risk ing; IGRA patients using descriptive statistical methods.
    [Show full text]
  • Medical Careers
    Medical Careers Overview Career development and advancement The Department of Health and Human Services offers Accredited Training Posts, excellent training, variety and Medical Practitioners diverse career opportunities and a an enviable lifestyle are all key features of medical careers commitment to professional growth. with the Department of Health and Human Services (DHHS) in Tasmania, which makes it a great place to start Key features of medical careers include: or build on your career in medicine. • excellent training and professional development We are dedicated to providing the highest standards of • best practice healthcare, by fostering a commitment to best practice • continuous improvement and continuous improvement, education and research. Healthcare in Tasmania is characterised by strong team • appreciation of education and research. work and close professional relationships with peers, Opportunities for medical practitioners are offered other health professionals and the community. throughout Tasmania in a variety of settings, including We recruit from all over Australia and the world, both urban and rural environments. which brings together the best training and professional experience, and a range of unique perspectives. We operate from more than 360 sites, including three high quality accredited teaching hospitals – the Royal As part of our commitment to the ongoing improvement Hobart Hospital, the Launceston General Hospital and the of health services for the community, we have formed North West Regional Hospital. a strategic alliance with the University of Tasmania’s Faculty of Health Science, called ‘Partners in Health’. We also provide opportunities in community settings. This partnership provides the ideal opportunity to These include mental health, palliative care, alcohol and integrate teaching, research and clinical service delivery, drug services, and community health centres.
    [Show full text]
  • New Zealand Out-Of-Hospital Acute Stroke Destination Policy Northland and Auckland Areas
    New Zealand Out-of-Hospital Acute Stroke Destination Policy Northland and Auckland Areas This policy is for the use of clinical personnel when determining the destination hospital for patients with an acute stroke in the out-of-hospital setting in the Northland and Auckland areas of New Zealand. It has been developed by the Northern Region Stroke Network in conjunction with the National Stroke Network and the Ambulance Sector. Publication date October 2020 Acute Stroke Destination Flowchart: Auckland Area Does the patient have signs or symptoms Stroke is unlikely, treat of an acute stroke? NO appropriately without YES using this policy. Perform additional screening using the PASTA tool Will the patient arrive at: NO NO A stroke hospital within 4 hours Does the patient Transport to the of symptom onset, or meet ‘wake-up’ most appropriate Auckland City Hospital within stroke criteria?1 hospital. 6 hours of symptom onset? YES YES Transport to the catchment YES PASTA positive? NO area hospital and notify hospital personnel of the Patient will arrive in ED 0800–1600, Mon–Fri following information: PASTA results and Transport to the most appropriate stroke hospital and notify hospital personnel as below: FAST results and Time of symptom onset and North Shore Hospital. Auckland City Hospital. NHI number Waitakere Hospital. Middlemore Hospital. Out of hours If the patient is in the North Shore Hospital, Notify hospital personnel Waitakere Hospital or Middlemore Hospital ASAP and provide the catchment: following information as a – Phone the on-call neurologist at Auckland City minimum: Hospital on 0800 1 PASTA as per the PASTA tool.
    [Show full text]
  • Community to Hospital Shuttle Service
    Is other transport assistance Total Mobility Scheme available? The Total Mobility Scheme is a subsidised taxi Best Care for Everyone Yes, there are several options available to those service. The scheme is available to people who qualify. who are unable to use public transport due to the nature of their disability. It works using vouchers that give a 50% discount on normal National Travel Assistance (NTA) Policy taxi fares. The scheme is part-funded by the NTA helps with travel costs for people who New Zealand Transport Agency and managed need to travel often or for long distances to get by the local authorities. to specialist health or disability services. The MAXX Contact Centre can provide the To receive this service, you need to be referred contact details for disability agencies that by your specialist (not your family doctor) to process applications. Call 09 366 6400 see another specialist or to receive specialist services. Both the specialists must be part of a St John Health Shuttle - Waitakere service funded by the government. The St John Health Shuttle provides safe, For example, this could be a renal dialysis reliable transport for Waitakere City residents centre, a specialist cancer service or a child to and from appointments with family doctors, development service. The rules are different treatment at Waitakere Hospital outpatient for children and adults, and for those holding clinics, visits to specialists, and transport to a Community Services Card. Sometimes, a and from minor day surgery. The vehicle is support person can receive assistance too. wheelchair accessible. The service operates Monday to Friday for appointments between How do I contact NTA? 9.30am and 2pm.
    [Show full text]
  • Initial Experience with Dabigatran Etexilate at Auckland City Hospital
    THE NEW ZEALAND MEDICAL JOURNAL Journal of the New Zealand Medical Association CONTENTS This Issue in the Journal 4 A summary of the original articles featured in this issue Editorial 7 A call for collaboration on inflammatory bowel disease in New Zealand Russell Walmsley Original Articles 11 The cost of paediatric and perianal Crohn’s disease in Canterbury, New Zealand Michaela Lion, Richard B Gearry, Andrew S Day, Tim Eglinton 21 Screening for Mycobacterium tuberculosis infection among healthcare workers in New Zealand: prospective comparison between the tuberculin skin test and the QuantiFERON-TB Gold In-Tube® assay Joshua T Freeman, Roger J Marshall, Sandie Newton, Paul Austin, Susan Taylor, Tony C Chew, Siobhan Gavaghan, Sally A Roberts 30 Audit of stroke thrombolysis in Wellington, New Zealand: disparity between in-hours and out-of-hours treatment time Katie Thorne, Lai-Kin Wong, Gerard McGonigal 37 Training medical students in Pacific health through an immersion programme in New Zealand Faafetai Sopoaga, Jennie L Connor, John D Dockerty, John Adams, Lynley Anderson 46 Insomnia treatment in New Zealand Karyn M O’Keeffe, Philippa H Gander, W Guy Scott, Helen M Scott 60 Evaluation of New Zealand’s bicycle helmet law Colin F Clarke 70 Sun protection policies and practices in New Zealand primary schools Anthony I Reeder, Janet A Jopson, Andrew Gray Viewpoint 83 Should measurement of vitamin D and treatment of vitamin D insufficiency be routine in New Zealand? Mark J Bolland, Andrew Grey, James S Davidson, Tim Cundy, Ian R Reid NZMJ 10 February 2012, Vol 125 No 1349; ISSN 1175 8716 Page 1 of 126 http://journal.nzma.org.nz/journal/125-1349/5068/ ©NZMA Clinical Correspondence 92 A case of yellow fever vaccine-associated disease Heather Isenman, Andrew Burns 96 An unusual cause of carotid sinus hypersensitivity/syndrome Donny Wong, Joey Yeoh 99 Medical image.
    [Show full text]
  • Annual Report 2007-08 1
    September 2008 The Hon Lara Giddings, MP, Attorney General Minister for Justice In accordance with the requirements of Section 84 of the Guardianship and Administration Act 1995, I am pleased to submit the report of the performance of the functions of the Guardianship and Administration Board for the year 1 July 2007 to 30 June 2008. Anita Smith PRESIDENT Guardianship and Administration Board Table of Contents Report of the Board and the President.............................................................................2 Role of the Board .........................................................................................................6 Applications.................................................................................................................8 Investigation and Case Management...............................................................................9 Emergency Applications .............................................................................................. 10 Hearings ................................................................................................................... 11 Reviews of Existing Orders .......................................................................................... 14 Client Profile.............................................................................................................. 15 Guardianship ............................................................................................................. 16 Registration of Enduring Guardianships ........................................................................
    [Show full text]
  • Proceedings of the Waikato Clinical Campus Biannual Research Seminar Wednesday 11 March 2020
    PROCEEDINGS Proceedings of the Waikato Clinical Campus Biannual Research Seminar Wednesday 11 March 2020 Ablation of ventricular patients (inability to locate PVC Pain relief options in arrhythmias at origin in a patient with multiple labour: remifentanil different morphologies, inad- Waikato Hospital vertent aortic puncture with no PCA vs epidural Janice Swampillai,1 E Kooijman,1 M sequelae, PVC focus adjacent to Dr Jignal Bhagvandas,1 Symonds,1 A Wilson,1 His bundle, cardiogenic shock Mr Richard Foon2 1 1 1 RF Allen, K Timmins, A Al-Sinan, during anaesthesia). Endo- 1Whangarei Hospital, Whangarei; D Boddington,2 SC Heald,1 MK Stiles1 cardial ablation was done in 96 2Waikato Hospital, Hamilton. 1Waikato Hospital, Hamilton; patients and three patients also Objective 2Tauranga Hospital, Tauranga. underwent epicardial ablation Remifentanil is commonly Background (one patient underwent two used in obstetrics due to its Catheter ablation can be an epicardial procedures including fast metabolism time. It is effective treatment strategy one open chest procedure). an attractive option for IV for patients with ventricular General anaesthesia was used patient-controlled analgesia tachycardia (VT) or frequent in 46% of cases, conscious (PCA) in labour. We compared premature ventricular sedation was used in 54%. the effi cacy of IV Remifen- complexes (PVCs). The goal is to Sixty-two percent were elective tanil PCA with epidural during improve quality of life as well as procedures and 38% were labour. mortality. done acutely. The overall acute Method success rate was 91%, falling to Objectives Using a retrospective We aimed to characterise 75% at three months, 73% at six approach, we identifi ed a our population of patients who months and 68% at 12 months.
    [Show full text]
  • Bloodstream Infection with Extended-Spectrum Beta-Lactamase-Producing Enterobacteriaceae at a Tertiary Care Hospital in New Zeal
    International Journal of Infectious Diseases 16 (2012) e371–e374 Contents lists available at SciVerse ScienceDirect International Journal of Infectious Diseases jou rnal homepage: www.elsevier.com/locate/ijid Bloodstream infection with extended-spectrum beta-lactamase-producing Enterobacteriaceae at a tertiary care hospital in New Zealand: risk factors and outcomes a, b c d Joshua T. Freeman *, Stephen J. McBride , Mitzi S. Nisbet , Greg D. Gamble , a e b Deborah A. Williamson , Susan L. Taylor , David J. Holland a Department of Clinical Microbiology, LabPlus, PO Box 110031, Auckland City Hospital, Auckland 1148, New Zealand b Department of Medicine, Middlemore Hospital, Auckland, New Zealand c Department of Infectious Diseases, Auckland City Hospital, Auckland, New Zealand d Department of Biostatistics, University of Auckland, Auckland, New Zealand e Department of Clinical Microbiology, Middlemore Hospital, Auckland, New Zealand A R T I C L E I N F O S U M M A R Y Article history: Objectives: To define local risk factors and outcomes for bacteremia with extended-spectrum beta- Received 26 July 2011 lactamase-producing Enterobacteriaceae (ESBL-E) at a tertiary hospital in New Zealand. Received in revised form 30 November 2011 Methods: Patients with ESBL-E bacteremia were compared to matched control patients with non-ESBL- Accepted 11 January 2012 producing Enterobacteriaceae bacteremia. Patients were matched by onset of bacteremia (community vs. Corresponding Editor: Karamchand Ramo- hospital), site of blood culture collection (peripheral vs. via central line), and infecting organism species. tar, Ottawa, Canada Results: Forty-four cases with matched controls were included. Eight- and 30-day mortality was higher in cases than controls (27% vs.
    [Show full text]
  • ADHB Neurology House Officer Run Description
    RUN DESCRIPTION POSITION: HOUSE OFFICER DEPARTMENT: Neurology PLACE OF WORK: Auckland City Hospital RESPONSIBLE TO: Business Manager Neuroservices through the Clinical Director Neurology and Clinical Neurophysiology Service FUNCTIONAL Healthcare consumer, Hospital and community based healthcare workers RELATIONSHIPS: PRIMARY OBJECTIVE: To facilitate the management of patients under the care of the Neurology Service. RUN RECOGNITION: Recognised as Category B for the purposes of registration by the Medical Council of New Zealand RUN PERIOD: 3 months Section 1: House Officer’s Responsibilities Area Responsibilities General Facilitate the management of inpatients commensurate with and appropriate to the house officer’s skill level; Manage the assessment and admission of acute and elective patients under the care of his/her team. Undertake clinical responsibilities as directed by the Registrar or Consultant, also organise relevant investigations, ensure the results are followed up, sighted and electronically signed; Be responsible, under the supervision of the Registrar and/or Consultant, to review inpatients on a daily basis (with the exception of unrostered weekends); Plan and deliver active anticancer treatment (as directed) Maintain a high standard of communication with patients, patients’ families and staff; Inform registrars/consultants of the status of patients especially if there is an unexpected event; Liaise with other staff members, departments, and General Practitioners in the management of in-patients; Communicate with patients and (as appropriate) their families about patients’ illness and treatment Prepare required paperwork on Friday prior to known or likely weekend discharges. Attend handover, Team and departmental meetings as required. ADHB Neurology House Officer Run Description- Effective 25 November 2013 Disclaimer: Please note that this run description is current at time of publication, however this information can be subject to change.
    [Show full text]
  • Patient Information Guide 2020/2021
    Patient Information Guide 2020/2021 PLEASE LEAVE THIS GUIDE IN YOUR LOCKER FOR THE NEXT PATIENT TO READ For your own copy of this guide, please scan the code with your smartphone camera and a digital download will begin. Scan Me Did you know? On average, 169 patients are admitted to the RHH each day. Over the last year, on average: • Over 185,000 visits were made to specialist outpatient clinics. • More than 60,000 Tasmanians visited our Emergency Department. • More than 1.15 million meals were produced by our Food Services team. • An average of 5.4 new Tasmanians are born each day. • Our Communications Unit handled more than 62,000 enquiries each month via the main switchboard. • Pathology Services performed more than 1.6 million tests. • Our Department of Medical Imaging processed more than 109,080 procedures (eg x-rays). Contents Site Directory 2 Leaving the Ward/Unit 11 Welcome 4 Library Service 11 Coming to the RHH 5 Mail 11 Aboriginal Health Liaison Officer 6 Medications 12 Alcohol and Drugs 6 Meals and Dietary Requirements 12 ATM Facilities 6 Multicultural Health Services 12 Allergies 6 Newspapers 13 Chaplaincy Service 6 Non-Acute Inpatients 13 Supporting Children as Inpatients 7 Patient Medical Records 13 Compliments, Suggestions and Private Patient Classification – Medicare Complaints 7 Eligible 14 Community Care 8 Medicare Ineligible 14 Dentures 8 Rights and Responsibilities – Dining Room 8 What You Should Know as a Patient 14 Discharge Procedures 8 Parking 16 Donations, Gifts and Bequests 9 Postal Service 16 Emergency Procedures and Fire Alarms 9 Public Toilets 16 Enquiries 9 Smoking 17 Hearing Aids 9 Television Service 17 Informed Consent 10 Travel Assistance Scheme 17 Identification of Patients 10 Valuables 17 Identification of Staff 10 Visiting Hours 18 Interpreter Service 11 Volunteer Network 19 Internet Access 11 Wheelchairs 19 Interviews with the Doctor 11 Wills 19 Kiosk 11 Local Community Services for Your Information 24 Laundry 11 1 The site map is current as of June 2020.
    [Show full text]
  • Dale Ding, M.D
    Dale Ding, M.D. Assistant Professor of Neurosurgery Department of Neurological Surgery University of Louisville School of Medicine 220 Abraham Flexner Way, 15th Floor Louisville, KY 40202 Academic Appointments 2018-present Assistant Professor of Neurosurgery Department of Neurological Surgery University of Louisville School of Medicine Louisville, Kentucky 2018-present Director of the Cerebrovascular and Endovascular Laboratory in Louisville (CELL) Department of Neurological Surgery University of Louisville School of Medicine Louisville, Kentucky 2018-present Local Site Director for Baptist Health Hospital Neurological Surgery Residency Program University of Louisville School of Medicine Louisville, Kentucky Licensure and Certification 2017-present Kentucky Board of Medical Licensure (License: 50866, Expiration: 2/29/2020) 03/2013 ABNS Primary Examination 08/2010 USMLE Step 3 12/2009 USMLE Step 2 CS 12/2009 USMLE Step 2 CK 01/2009 USMLE Step 1 Training 2017-2018 Fellowship in Endovascular Surgical Neuroradiology (ACGME and CAST accredited) Department of Neurological Surgery Barrow Neurological Institute Phoenix, Arizona 2015-2016 Fellowship in Cerebrovascular and Skull Base Surgery Department of Neurosurgery Auckland City Hospital Auckland, New Zealand 2014-2015 Research Fellowship in Cerebrovascular Disease Departments of Neurosurgery, Radiology and Medical Imaging, and Neurology University of Virginia Charlottesville, Virginia 2013-2014 Research Fellowship in Vascular Biology Robert M. Berne Cardiovascular Research Center University of Virginia Charlottesville, Virginia 2010-2017 Residency in Neurological Surgery Department of Neurosurgery University of Virginia Charlottesville, Virginia Education 2006-2010 M.D. Duke University School of Medicine 2008-2009 Clinical Research Training Program (CRTP) Duke University School of Medicine 2004-2006 B.S. in Biomedical Engineering, magna cum laude Washington University in St.
    [Show full text]
  • Tasmanian Health Service
    TASMANIAN HEALTH SER VIC NNUAL R E A EPO RT 2017 -18 ABOUT THIS REPORT The Tasmanian Health Service is required under section 53 of the Tasmanian Health Organisations Act 2011 to produce an annual report in respect of its operation, financial statements and other particulars as required under the Act. This is the final report under the Tasmanian Health Service Act 2011. As of 1 July 2018 the Tasmanian Health Service will operate and report under the Tasmanian Health Service Act 2018. Tasmanian Health Service Annual Report 2017-18 Tasmanian Health Service ©Crown in the Right of the State of Tasmania THS Executive Tasmanian Health Services 2018 PO Box 1963 LAUNCESTON TAS 7250 No part of this publication may be reproduced by any process except in accordance with the Phone (03) 6777 4129 provisions of the Copyright Act 1968. Email [email protected] Web www.ths.tas.gov.au Published October 2018 ISSN - 2206-9917 (Print) ISSN - 2206-9925 (Online) TASMANIAN HEALTH SERVICE | ANNUAL REPORT 2017-18 INTRODUCTION LETTER OF COMPLIANCE Hon Michael Ferguson MP Minister for Health Minister for Police, Fire and Emergency Management Minister for Science and Technology Leader of Government Business GPO Box 123 Hobart Tasmania 700 I Hon Peter Gutwein MP Treasurer Level 9, Executive Building, 15 Murray Street Hobart Tasmania 7000 Dear Ministers In accordance with the requirements of section 53 of the Tasmanian Health Organisations Act 2011 and section 27 of the Financial Management and Audit Act 1990, I as the delegate appointed am pleased to present the Annual Report 2017-18 and the financial statements for the Tasmanian Health Service.
    [Show full text]