Main Index
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Note: The printed version of this document includes the recommendations relevent to each section at the begining of each section. The electronic version here is different. Each recomendation in the Recomendation section (see below) in this site has links to the background and supporting arguments in the relevent section.
Foreword
Acknowledgements
Membership of Taskforce, Working Party
and Subgroups
List of Figures
List of Acronyms
Executive Summary and Recommendations
1. Setting the Scene
- Definition of Major Trauma
- The Scale of the Trauma Problem
- Causes of Trauma
- Trauma Prevention
- Trauma Management
- Trauma System Development
- Conclusion
2. The System
- The System
- Structure
- Major Trauma Services in Victoria - Consideration
of
Number and Location - Role Delineation and Hospital Designation
- System Organisation and Management
3. System Support and Development
- Triage and Transfer
- Clinical Management
- Communications
- Retrieval and Transfer
- Quality Management
- Education and Training
- Research, Service and Technology Developments
- Funding
4. Bibliography
5. Appendices
- Terms of ReferenceMinisterial Taskforce on Trauma
and Emergency Services - Terms of ReferenceWorking Party on Emergency
and Trauma Services - Trauma Distribution in Victoria (ISS>15)
- Recommended Role Delineation Guidelines
Major Trauma Service and Metropolitan Trauma Service - Recommended Role Delineation Guidelines - Regional
Trauma Services, Urgent Care Services, Primary Injury Services - Proposed Designation for Trauma Services
6.1 Proposed Designation for Trauma Services in Metropolitan Melbourne
6.2 Proposed Designation for Trauma Services in Rural Victoria - Triage and Transfer Guidelines
7.1 Setting for Triage Guidelines in the Trauma System
7.2 Prehospital Major Trauma Criteria
7.3 Destination Decision
7.4 Major Trauma Interhospital Transfer Guidelines - Specialist Trauma Transfer Guidelines
8.1 Neurotrauma
8.2 Spinal Trauma
8.3 Barotrauma
8.4 Paediatric Trauma
8.5 Obstetric Trauma
8.6 Burns
8.7 Musculoskeletal Trauma - Current Medical Retrieval in Victoria
- Retrieval Activation Sequence
- Trauma Team Composition
- Role Description of Director of Trauma Services
- Recommended Organisational Framework for Emergency
and Critical Care Services in Victoria: Trauma Services - Recommended Roles and Responsibilities Ministerial
Emergency and Critical Care Committee - Recommended Terms of Reference State Trauma Committee
- Recommended Roles and Responsibilities Major
Trauma
Service Statewide Coordination Unit - Sample Terms of Reference Regional Consultative
Committee on Emergency and Critical Care Services
Foreword
The impact of trauma, in both human and financial terms, is significant. It has been estimated that for every trauma related death in Australia, there are 47 hospital admissions, 133 emergency department visits, and 1,333 private doctor visits. These figures are staggering in themselves, however the suffering behind these statistics is even more significant.
Victoria is already a national and international leader in trauma prevention and care. The success of injury prevention campaigns in this state is testimony to the commitment and vigour of a number of agencies. The current clinical outcomes for trauma patients are comparable to, and in some aspects better than, international standards.
Despite this, a number of bodies have identified the need for system-wide changes in the management of trauma patients to further reduce the impact of trauma in this State. This is supported by research undertaken over the last five years. In 1997, the Minister for Health, the Hon Rob Knowles MP, established the Ministerial Taskforce on Trauma and Emergency Services to advise the Government on a best practice model responsive to the particular needs of critically ill trauma patients. Victorian Government support for such a system is an example of its commitment to providing specialised, efficient services and improving access to these services.
The Taskforce has been cognisant that health care providers encounter particular challenges in providing care to trauma patients in isolated rural areas. These health care providers are crucial to the outcome of patients injured in these areas and provide care under often difficult conditions. The Taskforce has sought to address these difficulties.
I have been privileged to chair this Taskforce for the Minister. The members of the Taskforce and Working Party have come from the spectrum of professional groups providing care to trauma patients, from institutions involved in education and research in this field, from other provider and consumer groups, and from the Department of Human Services. All have brought a passion for improving trauma care, substantial expertise and enormous generosity with their time.
Planning a complex, integrated trauma system necessarily involves a complex planning process. In the course of this review, there were 24 occasions when the Taskforce or Working Party met. Sixteen papers and reports assisted the Taskforce and Working Party in their deliberations. Seven subgroups provided detailed submissions in focus areas, such as role delineation, education, medical retrieval, neurosurgery, paediatrics, ambulance communications and system monitoring. Consultation with groups, such as the regional Consultative Committees on Emergency and Critical Care, also provided invaluable perspectives on important issues.
The Taskforce recommendations are made with consideration of the wider spectrum of emergency medical conditions. Developments to the system of care are intended to address the identified deficiencies in trauma management, but it is also acknowledged that some of the benefits will flow on to related emergency patient populations.
The system recommended by the Taskforce and Working Party involves a number of strategies, including:
- The establishment of a process for the prehospital triage and transfer of trauma patients to the most appropriate hospital within an appropriate timeframe. This will involve ambulance bypass of some hospitals.
- The establishment of guidelines for the interhospital transfer of trauma patients. These guidelines establish a standard for ensuring that trauma patients are managed at the most appropriate hospital for the type and severity of injury within an appropriate timeframe.
- The role delineation of health services to provide varied levels of trauma care.
- The designation of health services to fulfil specific roles within the system. In particular, the establishment and designation of Major Trauma Services at The Alfred, the Royal Children's Hospital and the Royal Melbourne Hospital. These hospitals will have a statewide responsibility for trauma care.
- Enhancement of the role of medical retrieval services, in particular, a streamlining of the activation processes.
- Plans for trauma care in rural areas that will be developed by the regional Consultative Committees on Emergency and Critical Care, utilising the framework developed by the Taskforce.
- A process of audit and quality assurance that will provide ongoing monitoring of outcomes from trauma care.
This report provides the blueprint for building a world-class trauma system. It will provide Victorians with the best framework and measures for optimising the management of trauma. I thank the Taskforce, Working Party and others whose contributions have created this document and I commend this report to the Minister for Health, the Hon Rob Knowles MP.
ROBERT DOYLE MP
Parliamentary Secretary to the Minister for Health
Chair, Ministerial Taskforce on Trauma and Emergency Services
