Hospital Circulars

Hospital Circular 14/2002

Date Issued: 10 July 2002

Publication: 14/2002

Contact: Gavin Jackson, Manager Trauma System Coordination Unit 9616 2506

Distribution:

• Ambulance Services
• Public Hospitals
• Private Hospitals

Subject: Metropolitan Major Trauma Triage Guidelines

Date Of Implementation: 15 July 2002

Purpose: To notify hospitals and ambulance services that the Metropolitan Major Trauma Triage Guidelines, directing major and suspected major trauma patients to Major Trauma Services, will come into effect on 15 July 2002.

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Background:

• The Ministerial Taskforce report Review of Trauma and Emergency Services (the ROTES report) established a framework for the treatment of major trauma patients. The development of an integrated system was seen to be necessary following research into trauma in Victoria which found that 30% of major trauma related deaths were preventible or potentially preventible.
• The introduction of Metropolitan Major Trauma Triage Guidelines will increase the proportion of major trauma patients treated at a Major Trauma Service and will be a key development in the implementation of the Victorian State Trauma System.
• The Metropolitan Major Trauma Triage Guidelines instruct ambulance services to triage adult major trauma patients and suspected adult major trauma patients directly to an adult Major Trauma Service (The Alfred and the Royal Melbourne Hospital), when the travel time is less than 30 minutes.
• If a Major Trauma Service is not within 30 minutes travel time, then the patient should be triaged to the highest level trauma service within the 30 minute timeframe.
• Further guidelines will be provided in October on the triage of paediatric major trauma patients to the Royal Children's Hospital.
• A Trauma Advice and Referral telephone line has been established to assist with the provision of clinical advice regarding the management of trauma patients and to coordinate the referral and transfer of patients to the Major Trauma Services. Clinicians are able to call 1800 700 001 to speak with a senior trauma consultant at either of the adult Major Trauma Services or the Royal Children's Hospital.
• Neurotrauma patients requiring critical care support should be managed only in hospitals with a neurosurgical unit and neurological support. Interhospital transfer under conditions of neurological deterioration is to be avoided whenever possible by timely and proactive transfer of such patients to a Major Trauma Service.
• Major trauma including spinal trauma should initially be triaged to a Major Trauma Service. Early consultation by each treating hospital with the Victorian Spinal Cord Unit at the Austin and Repatriation Medical Centre is essential to optimise patient outcomes.

Guidelines:

The Major Trauma Triage Guidelines require:

1. Major trauma to be identified in the pre-hospital setting according to specified physiological and anatomical criteria (attached).
2. Major trauma (including isolated spinal cord trauma) be triaged to the Major Trauma Services in the pre-hospital setting, within the defined safety and logistic constraints.
3. Triage to a Major Trauma Service where a major trauma patient is less than 30 minutes transport time from a Major Trauma Service.
4. Triage to the highest designated trauma service accessible in 30 minutes where a major trauma patient is more than 30 minutes transport time from a Major Trauma Service.
5. Where a major trauma patient appears to be in an immediately life-threatening situation during transport, the patient be diverted to the nearest designated trauma service for stabilisation, with subsequent transport to a Major Trauma Service at the earliest appropriate time.
6. Where a patient is triaged initially to a non-Major Trauma Service for stabilisation, early liaison with the Major Trauma Service occur via the Trauma Advice and Referral telephone line, and consideration be given to appropriate medical retrieval or interhospital transfer to a Major Trauma Service.

Major Trauma Service Designation:

The following hospitals are the highest level of adult trauma services and are designated Major Trauma Services (MTS):

Royal Melbourne Hospital; and
The Alfred.

The following hospitals are the second level of adult major trauma services and are designated Metropolitan Trauma Services (MeTS):

Austin and Repatriation Medical Centre
Box Hill Hospital
Dandenong Hospital
Maroondah Hospital
Monash Medical Centre, Clayton
Mornington Peninsula Hospital, Frankston
St Vincent's Hospital
The Northern
Western Hospital

The following hospitals are the lowest level of adult major trauma services and are designated Primary Care Services (PCS):

Mornington Peninsula Hospital, Rosebud
Sandringham and District Memorial Hospital
Sunshine
The Angliss
The Mercy, Werribee
Williamstown Hospital
(Private Hospitals with Emergency Departments when authorised under Hospital Circular 4/1998)

Monitoring and Review:

The Department of Human Services will continue to monitor and liaise with the Major Trauma Services to assess the impact on services at The Alfred and the Royal Melbourne Hospital following the introduction of the Guidelines.

Adult Pre Hospital Major Trauma Criteria (pdf file, 10kb)

Shane Solomon
Executive Director
Metropolitan Health & Aged Care Services