Trauma triage guidelines & prehospital criteria

Paediatric and adult prehospital major trauma criteria

The prehospital major trauma criteria assist the initial clinical assessment and identification of a major trauma patient.  This information then guides clinicians and paramedics’ communication with Adult Retrieval Victoria and activation of the VSTS as appropriate.

Metropolitan and regional paediatric and adult major trauma triage guidelines

The major trauma triage guidelines describe the activation protocols for the VSTS for a major trauma patient.

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.

Adult Retrieval Victoria 1300 36 86 61

Adult Retrieval Victoria (ARV) provides a comprehensive range of management and coordination services to clinicians treating trauma patients.  This includes telephone advice on the care of critically ill patients, assessment and management of retrieval and coordination of critical care beds across the state.  ARV has assumed responsibility for the Trauma Advice and Referral Line (1800 700 001), that prior to 2008 was the single entry point to the Victorian State Trauma System for clinicians treating trauma patients. 

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 the 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.

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)
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 to 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 Adult Retrieval Victoria 1300 36 86 61, and consideration 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 to be triaged to the Royal Children’s Hospital
9. all trauma services receiving spinal trauma patients to consult the Victorian Spinal Cord Service early after patient reception to optimise patient outcomes.
   • Location and role of Victoria’s trauma services

Clinical guidelines

The following clinical guidelines have been developed to assist clinicians managing patients who have sustained major trauma.  

Other clinical guidelines are currently being developed.

Cervical spine acute care guidelines - February 2006 (PDF 801 KB)