Appendix
4 (Part 1 - Part 2)
Recommended
Role Delineation Guidelines—Major
Trauma Service and Metropolitan Trauma Service
Note: Development of the role delineation guidelines for trauma services in Victoria have been developed by adapting the guidelines established by the NRTAC in 1993. Modification of the guidelines is intended to provide increased definition to the type of services required. In reading these guidelines it is important to note that they are intended to describe the services required for trauma management only. Services not essential for the role of the service within the system may be required for other functions of the hospital.
|
Prehospital Transport and Care |
Major Trauma Service |
Metropolitan Trauma Service |
|
Triage protocols |
Essential |
Essential |
|
Communications with hospital medical officer |
Essential |
Essential |
|
Site medical team capacity: disaster |
Essential |
Essential |
|
Participation in statewide retrieval service |
Essential |
Desirable |
|
Prehospital notification system |
Essential |
Essential |
|
Hospital Organisation |
||
|
Designation as Trauma Service |
Essential |
Essential |
|
Director of Trauma Service |
Essential |
Essential |
|
Trauma Committee |
Essential |
Essential |
|
Organisational chart |
Essential |
Essential |
|
Surveillance data systems |
Essential |
Essential |
|
Written procedural guidelines |
Essential |
Essential |
|
Written management protocols |
Essential |
Essential |
|
Transfer protocols |
Essential |
Essential |
|
Emergency Department |
Major Trauma Service |
Metropolitan Trauma Service |
|
i/ General |
||
|
General criteria as established by ACHS |
Essential |
Essential |
|
Documented policies and protocols |
Essential |
Essential |
|
24-hour operation |
Essential |
Essential |
|
Direct communication with amb. vehicle (1) |
Essential |
Essential |
|
Single point for referrals |
Essential |
Essential |
|
Ambulance access |
Essential |
Essential |
|
Helicopter access |
On-site |
Where appropriate |
|
Triage on arrival |
Essential |
Essential |
|
Designated Medical Director of ED |
Essential |
Essential |
|
Consultant (FACEM) 24 hours |
On-site |
On call < 30 min |
|
Medical Officer(s) with EMST training |
Essential |
Essential |
|
Medical Officer(s) 24 hours - Registrar |
Desirable |
Essential |
|
Nursing staff with trauma training (24 hr) (2) |
Essential |
Essential |
|
ii/ Access to Surgical Specialities |
||
|
General Surgery |
Registrar
(4th year or more) in-house 24-hr Consultant
< 15 min desirable, |
Registrar
in-house 24-hr.Consultant
< 30 min desirable, |
|
Surgical Trauma Fellow |
Desirable |
- |
|
Orthopaedic |
Registrar and Consultant < 30 min |
Registrar
and Consultant <
30 min desirable |
|
Neurosurgery (3) |
Registrar (4th year or more) 24-hr and specialist neurosurgeon available within < 30 min |
Specialist neurosurgeon available for phone consult 24 hours and available to attend in < 45 min |
|
Vascular |
Registrar
< 30 min |
Consultant
< 30 min desirable, |
|
Cardiothoracic |
Registrar
24-hr in-house |
Consultant
< 30 min desirable, |
|
Paediatric Surgeon |
Consultant < 30 min at Paed MTS |
Consultant
< 30 min desirable, |
|
Plastic |
Consultative on call |
Consultative on call |
|
Ophthalmic |
Consultative on call |
Consultative on call |
|
ENT |
Consultative on call |
Consultative on call |
|
Faciomaxillary |
Consultative on call |
Consultative on call |
|
Urology |
Consultative on call |
Consultative on call |
|
iii/ Access to Other Specialities |
||
|
Anaesthesia |
Registrar and Consultant in-house 24-hr (4) |
Registrar in-house and Consultant on call < 30 min |
|
Intensive Care |
Registrar in-house and Consultant 30– 60 min |
Registrar in-house and Consultant < 60 min |
|
Internal Medicine |
Consultative on call |
Consultative on call |
|
Paediatrician |
Consultation with RCH |
Consultation with RCH |
|
Haematology |
Consultative on call |
Consultative on call |
|
Nephrology |
Consultative on call |
Consultative on call |
|
Infectious Diseases |
Consultative on call |
Consultative on call |
|
Psychiatry |
Consultative on call |
Consultative on call |
|
Radiology |
Registrar < 30 min, Consultant on call |
Registrar
< 30 min desirable, |
(1) The Taskforce
and Working Party recognise that while this requirement is not currently
consistently available, development in digital communications technology
over the next few years will make this more technically viable.
(2) The Taskforce and Working Party recognise that there is currently
not a recognised standard course for nursing trauma management. The development
of this in Victoria is a long term aim.
(3) Neurosurgical registrar: desirable in-house 24 hours, essential on
call <30 min. The implemetation of this requirement is subject to the
availability of accredited neurosurgical training positions.
(4) A MTS must have the capacity to recall a second anaesthesist.