Metropolitan and Regional Paediatric and Adult
Major Trauma Triage Guidelines
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 Department of Human Services introduced Metropolitan Trauma Triage
Guidelines in July 2002. The introduction of Major Trauma Triage Guidelines
is intended to increase the proportion of major trauma patients treated
at a Major Trauma Service; the introduction of the Guidelines is a key
development in the implementation of the Victorian State Trauma System.
The Guidelines
Adult Patients
Ambulance services should 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.
Paediatric Patients
Ambulance services should triage paediatric major trauma patients and
suspected paediatric major trauma patients directly to the Royal Children’s
Hospital when travel time is less than 30 minutes.
Trauma Advice and Referral Line 1800 700 001
The department introduced the Trauma Advice and Referral telephone
line to provide clinical advice and support to clinicians managing major
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.
Specialist Trauma Triage and Transfer
Hospitals with neurosurgical specialities should manage neurotrauma
patients requiring critical care support. All health services are advised
to avoid patient deterioration during interhospital transfer by the 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 Hospital is essential
to optimise patient outcomes.
Discrete spinal cord injured patients, in the absence of other indicators
of major trauma, should be triaged to Austin Health’s, Victorian
Spinal Cord Service by telephoning (03) 9496 5000 and asking for Spinal
Unit Acute Registrar.
Multiple trauma, incorporating the need for microsurgery, should be
referred and transferred to a Major Trauma Service. However, St Vincent’s
Hospital should be consulted in their capacity as leaders in the management
of injuries requiring microsurgery.
Isolated injuries requiring microsurgery should be referred and transferred
according to established referral patterns; this would include St Vincent’s
Hospital in the majority of cases.
Neurosurgical triage and transfer guidelines for major trauma still
apply in rural areas, even where a neurosurgical specialist practises
locally, as the management of these patients requires all the appropriate
and agreed service supports of a Major Trauma Service.
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Major Trauma Triage Guidelines Require:
1. Pre-hospital major trauma to be identified according to specified
physiological and anatomical criteria (see adult and paediatric pre-hospital
major trauma criteria below).
2. Triage to a Major Trauma Service where a major trauma patient is
less than 30 minutes transport time from a Major Trauma Service.
3. 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.
4. Triage to a designated trauma service accessible in the least amount
of time in isolated rural areas that are more than 30 minutes from any
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 1800 700 001, and consideration
be given to appropriate medical retrieval or interhospital transfer to
a Major Trauma Service.
7. Discrete spinal cord trauma to be triaged to the Austin Health, within
the defined safety and logistic constraints .
8. All spinal trauma in paediatric patients be triaged to the Royal
Children’s Hospital.
9. All trauma services receiving spinal trauma patients should consult
the Victorian Spinal Cord Service early after patient reception to optimise
patient outcomes.
Major Trauma Service Designation
Major Trauma Services
The following hospitals are the highest level of adult trauma services
and are designated Major Trauma Services (MTS):
- Melbourne Health: Royal Melbourne Hospital; and
- The Alfred.
The following hospital is the highest level of paediatric trauma service
and is designataed Major Trauma Service (MTS)
- Royal Children’s Hospital
Metropolitan Trauma Services
The following metropolitan hospitals are the second level of adult
and paediatric major trauma services and are designated Metropolitan
Trauma Services (MeTS):
- Austin Health
- Eastern Health: Box Hill Hospital
- Southern Health: Monash Medical Centre, Clayton Dandenong Hospital
- Peninsula Health: Frankston Hospital,
- Northern Health: The Northern Hospital
The following are designated MeTS hospitals for adult patients only:
- Eastern Health: Maroondah Hospital
- Sisters Of Charity Health Service Melbourne: St Vincent’s
Health
- Western Health: Western Hospital
Metropolitan Primary Care Services
The following metropolitan hospitals are the lowest level of adult
and paediatric major trauma services and are designated Primary Care
Services (PCS):
- Peninsula Health: Rosebud Hospital
- Bayside Health: Sandringham and District Memorial Hospital
- Western health: Sunshine Hospital
- Eastern Health: The Angliss Health Services
- Mercy Public Hospitals Inc: The Mercy Hospital, Werribee
- Western Health: Williamstown Hospital
- (Private Hospitals with Emergency Departments when authorised under
Hospital Circular 4/1998)
Regional and Rural
Trauma Services in regional and rural Victoria fit within a three-tiered
hierarchical structure:
1. Regional Trauma Services (RTS)
2. Urgent Care Services (UCS)
3. Primary Care Services (PCS).
Services by region are as follows:
BARWON SOUTH WEST REGION
Regional Trauma Service
- Barwon Health - The Geelong Hospital
- South West Health Care - Warrnambool
- Western District Health Service – Hamilton
Urgent Care Service
- Casterton Memorial Hospital
- Coleraine District Health Services
- Colac Area Health– Colac
- Hesse Rural Health Service -Winchelsea
- Lorne Community Hospital
- Moyne Health Services – Port Fairy
- Portland and District Hospital
- South West Health Care – Camperdown
- Terang and Mortlake Health Service
- Timboon and District Health Care Service
- Otway Health and Community Service - Apollo Bay
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Primary Care Service
- Colac Area Health Services – Birregurra
- South West Health Care - Lismore
- Hesse Rural Health Service – Rokewood
- Hesse Rural Health Service - Beeac
- Heywood Rural Health
- Terang and Mortlake Health Service – Mortlake
- Western District Health Service –Penshurst
Private Facilities
- Balmoral Bush Nursing Centre
- Cobden District Health Service
- Dartmoor Bush Nursing Centre
- Merino Health Services
GIPPSLAND REGION
Regional Trauma Service
- Latrobe Regional Hospital
Urgent Care Service
- Bairnsdale Regional Health Service
- Gippsland Southern Health Service - Leongatha
- Gippsland Southern Health Service - Korumburra
- Central Gippsland Health Service - Sale
- Orbost Regional Health
- South Gippsland Hospital - Foster
- West Gippsland Health Care Group - Warragul
- Wonthaggi and District Hospital
- Yarram and District Health Service
Private Facilities
Primary Care Service
- Omeo District Hospital
- Lakes Entrance Community Health Centre
Private Facilities
- Buchan Bush Nursing Centre
- Cann Valley Bush Nursing Centre
- Dargo Bush Nursing Centre
- Gelantipy Bush Nursing Centre
- Heyfield Hospital
- Mallacoota Medical Centre
- Mt Baw Baw Medical Centre
- Neerim District Soldiers Memorial Hospital
- Swift’s Creek Bush Nursing Centre
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GRAMPIANS REGION
Regional Trauma Service
- Ballarat Health Services – Ballarat Base Hospital
- Wimmera Health Care Group - Wimmera Base Hospital
Urgent Care Service
- East Grampians Health Service – Ararat
- East Wimmera Health Service - St Arnaud
- Edenhope and District Hospital
- Hepburn Health Service - Daylesford
- Stawell Regional Health
- West Wimmera Health Service - Nhil
- Rural North West Health - Warracknabeal
Private Facilities
- St John of God Hospital - Ballarat
Primary Care Service
- Beaufort and Skipton Health Service - Beaufort
- Beaufort and Skipton Health Service - Skipton
- Djerriwarrh Health Service - Bacchus Marsh
- East Wimmera Health Service - Donald
- East Wimmera Health Service - Charlton
- East Wimmera Health Service - Wycheproof
- East Wimmera Health Service - Birchip
- Hepburn Health Service - Creswick
- Rural Northwest Health - Hopetoun
- Wimmera Health Care Group - Dimboola
- Dunmunkle Health Service - Rupanyup
- West Wimmera Health Service - Jeparit
- West Wimmera Health Service - Kaniva
- West Wimmera Health Service - Rainbow
- Elmhurst Bush Nursing Centre
- Harrow Bush Nursing Centre
- Woomelang Bush Nursing Centre
- Lake Bolac Bush Nursing Centre
Private Facilities
- Ballan District Health and Care
- Rural Northwest Health - Beulah Pioneers’ Bush Nursing Hospital
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HUME REGION
Regional Trauma Service
- Goulburn Valley Health (GVBH) Shepparton
- Northeast Health Wangaratta
- Albury Base Hospital
Urgent Care Service
- Alexandra District Hospital
- Alpine Health - Bright, Mt Beauty, Myrtleford
- Benalla and District Memorial Hospital
- Cobram District Hospital
- Kilmore and District Hospital
- Numurkah District Health Service
- Mansfield District Hospital
- Seymour District Memorial Hospital
- Upper Murray Health and Community Service - Corryong
- Wodonga Regional Health Service
- Yarrawonga District Health Service
- Yea and District Memorial Hospital
Primary Care Service
- Nathalia District Hospital
- Tallangatta Health Service
- Beechworth Health Service
Private facilities
- Chiltern and District Community Health Service
- Euroa Health Inc.
- Falls Creek Medical Centre
- Mt Buller Medical Centre
- Mt Hotham Medical Centre
- Nagambie Medical Centre
- Violet Town Bush Nursing Centre
- Walwa Bush Nursing Centre
- Yackandandah Bush Nursing Hospital
LODDON MALLEE
Regional Trauma Service
- Bendigo Health Care Group
- New Mildura Base Hospital
Urgent Care Service
- Cohuna District Hospital
- Echuca Regional Health
- Kerang and District Hospital
- Kyabram and District Health Service
- Kyneton District Health Service
- Maryborough District Health Service
- Mt Alexander Hospital
- Swan Hill District Hospital
Primary Care Service
- Boort District Hospital
- Inglewood and District Health Service
- Maldon Hospital
- Mallee Track Health and Community Service
- Manangatang and District Hospital
- McIvor Health and Community Service
- Robinvale District Hospital and Health Service
- Rochester and Elmore District Health Service
Private Facilities
- Dingee Bush Nursing Centre
- Lockington Bush Nursing Corp.
- Pyramid Hill Bush Nursing Hospital
- Sea Lake and District Health Service
- Monitoring and Review
The Department of Human Services will continue to monitor and liaise with
all hospitals within the Victorian State Trauma System to assess the impact
on services and patient outcomes following the introduction of the Guidelines.
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