Review of Trauma & Emergency Services Appendix 5

Appendix 5 (Part 1 - Part 2)
Recommended Role Delineation Guidelines—Regional Trauma Services, Urgent Care Services and Primary Injury Services

Note: 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 considered not essential for the role of the service within the system may be required for other functions of the hospital.

	Regional Trauma Service	Urgent Care Service	Primary Injury Service
Prehospital Transport and Care
Triage protocols	Essential	Essential	Essential
Communications with service staff	Essential	Essential	Essential
Site medical team capacity	Essential	Essential	Desirable
Hospital Organisation
Designation as Trauma Service	Essential	Essential	Essential
Director of Trauma Service	Essential	Essential	Not applicable (NA)
Trauma Committee	Essential	Essential	Desirable
Organisational chart	Essential	Essential	Desirable
Surveillance data systems	Essential	Essential	Desirable
Written procedural guidelines	Essential	Essential	Essential
Written management protocols	Essential	Essential	Essential
Transfer protocols	Essential	Essential	Essential
Emergency Department
i/ General
General criteria as established by ACHS	Essential	Essential	Desirable
Documented policies and protocols	Essential	Essential	Essential
24-hour operation	Essential	Essential	Desirable
Radio communication with ambulance vehicle	Essential	Essential	Essential
Single point referral for referrals	Essential	Essential	Essential
Ambulance access	Essential	Essential	Essential
Helicopter access	Essential	Essential	Essential
Triage on arrival	Essential	Essential	Essential
Designated Medical Director of ED	Essential	Essential	Desirable
Medical officer(s) with EMST training	Essential	Essential	Desirable
Medical officer (s) 24 hours	Essential	NA	NA
Medical officer(s) on call (15 minutes)	NA	Essential	Desirable
Nursing staff with trauma training (8)	Essential	Desirable	Desirable

ii/ Access to Surgical Specialities	Regional Trauma Service	Urgent Care Service	Primary Injury Service
General Surgery	Registrar and Consultant < 30 min	Telephone consultation available	Telephone consultation available
Orthopaedic	Desirable	Telephone consultation available	Telephone consultation available
Neurosurgery	Desirable	Telephone consultation available	Telephone consultation available
Vascular	Desirable	Telephone consultation available	Telephone consultation available
Plastic	Desirable	Telephone consultation available	Telephone consultation available
Cardiothoracic	Desirable	Telephone consultation available	Telephone consultation available
Ophthalmic	Desirable	Telephone consultation available	Telephone consultation available
ENT	Desirable	Telephone consultation available	Telephone consultation available
Faciomaxillary	Desirable	Telephone consultation available	Telephone consultation available
Urology	Desirable	Telephone consultation available	Telephone consultation available

iii/ Access to Other Specialities
Anaesthesia	Essential	Essential (9)	NA
Intensive Care	Essential	NA	NA
Paediatrics	Desirable	Telephone consultation available	Telephone consultation available
Haematology	Desirable	NA	NA
Nephrology	Desirable	NA	NA
Infectious Diseases	Desirable	NA	NA
Psychiatry	Desirable	NA	NA
Radiology
Plain XR- 24 hours	Essential	Desirable	NA
Angiography within 30 min	Desirable	NA	NA
CT scan within 15 minutes	Desirable	NA	NA
CT scan within 1 hour	Essential	Desirable	NA
Ultrasound within 15 min	Desirable	NA	NA
Ultrasound within 1 hr	Essential	Desirable	NA
Echocardiography within 1 hr	Desirable	NA	NA

Pathology	Regional Trauma Service	Urgent Care Service	Primary Injury Service
ABGs stat 24 hrs	Essential	Desirable	NA
Blood delivery within 1 hour	Essential	Desirable	NA
Electrolytes stat 24 hours	Essential	Desirable	NA
Coag. studies within 1 hour	Essential	Desirable	NA

Operating and Recovery Room
General criteria as established in ACHS Accreditation Guide (13th Ed.)	Essential	Essential	Essential
	Essential	Essential	Essential
Emergency OR available 24 hours:
- within 30 minutes	Desirable	NA	NA
- within 1 hour	Essential	NA	NA
Specialised equipment:
- Neurosurgical instrumentation	As required	NA	NA
- Image intensifier	Essential	NA	NA
- Operating microscope	As required	NA	NA
- Portable X-Ray	Essential	NA	NA
- Cardiopulmonary bypass	NA	NA	NA

Quality Assurance, Training and Research
General criteria as established by ACHS	Essential	Essential	Essential
QA organisational structure	Essential	Essential	Essential
Trauma outcome studies	Essential	Essential	Essential
Trauma research programs	Essential	-	-
Trauma training programs:
- staff medical officers	Essential	Essential	Essential
- nurses	Essential	Essential	Essential
- allied health personnel	Essential	Essential	Essential

Community Education ⁽¹⁰⁾	Essential	Desirable	Desirable

Disaster Plan ⁽¹⁰⁾	Essential	Essential	Essential

(8) 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.
(9) It is likely that anaesthetic availability at Urgent Care Services will be provided by appropraitely skilled General Practitioners
(10) The undertaking of the higher level system activities including quality assurance, training, research and community education is to be developed, planned and undertaken on a regional level with steering of these functions by the regional CCECCS.

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