Hospital Circulars

Hospital Circular 29/2002

Date Issued: 30 September 2002

Publication: 29/2002

Contact: Alison McMillan, Manager Clinical Governance Unit 9616 8237

Distribution: Ambulance Services, Public Hospitals, Private Hospitals

Subject: Metropolitan and Regional Paediatric and Adult Major Trauma Triage Guidelines

Date Of Implementation: These Guidelines come into effect on 14 October 2002.

This Circular supersedes Hospital Circular 14/2002 "Metropolitan Major Trauma Triage Guidelines".

Purpose: To notify hospitals and ambulance services that the Metropolitan Major Trauma Triage Guidelines, directing major and suspected major trauma patients to Major Trauma Services, has been updated to

1. Include paediatric trauma patients.
2. Include Regional Major Trauma Triage Guidelines.
3. Enhance indicators of major trauma.

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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.
• Metropolitan Trauma Triage Guidelines were introduced in July 2002 via the distribution of Hospital Circular 14/2002.
• 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.

Metropolitan and Regional Major Trauma Triage Guidelines

• Hospital Circular number 14/2002, "Metropolitan Major Trauma Triage Guidelines", provided instruction on the triage of adult major trauma patients in the Metropolitan area. The triage of adult major trauma patients in regional and rural Victoria has now been included in the Trauma Triage Guidelines.
• The Metropolitan and Regional Major Trauma Triage Guidelines instruct ambulance services to 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 Major Trauma Triage Guidelines

• Hospital Circular number 14/2002, "Metropolitan Major Trauma Triage Guidelines", provided instruction on the triage of adult major trauma patients only. Paediatric trauma patients have now been included in the Trauma Triage Guidelines.
• 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

• A Trauma Advice and Referral telephone line has been established to assist with the provision of clinical advice regarding the management of 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

• Neurotrauma patients requiring critical care support should be managed only in hospitals with a neurosurgical unit and neurological support. Interhospital transfer under conditions of neurological deterioration is to be avoided whenever possible by 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 and Repatriation Medical Centre is essential to optimise patient outcomes.
• Discrete spinal cord injury, in the absence of other indicators of major trauma should be triaged to the Austin and Repatriation Medical Centre or a Major Trauma Service (whichever is the closest) providing the travel time is less than 30 minutes.
• 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.

Guidelines:

The Major Trauma Triage Guidelines require:

1. Major trauma to be identified in the pre-hospital setting according to specified physiological and anatomical criteria (separate adult and paediatric trauma criteria are attached).
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, 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 and Repatriation Medical Centre or a Major Trauma Service, 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):

Royal Melbourne Hospital; and
The Alfred.

The Royal Children's Hospital is the highest level of paediatric trauma service and is designated a MTS.

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 and Repatriation Medical Centre
Box Hill Hospital
Dandenong Hospital
Monash Medical Centre, Clayton
Mornington Peninsula Hospital, Frankston
The Northern

The following hospitals are designated as MeTS for adult patients only:

Maroondah Hospital
St Vincent's Hospital
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):

Mornington Peninsula Hospital, Rosebud
Sandringham and District Memorial Hospital
Sunshine Hospital
The Angliss Health Services
The Mercy Hospital, Werribee
Williamstown Hospital
(Private Hospitals with Emergency Departments when authorised under Hospital Circular 4/1998)

Trauma Services in regional and rural Victoria (outlined at Attachment 3) fit within a three-tiered hierarchical structure:

1. Regional Trauma Services (RTS)
2. Urgent Care Services (UCS)
3. Primary Care Services (PCS).

Monitoring and Review:

The Department of Human Services will continue to monitor and liaise with the Major Trauma Services to assess the impact on services at The Alfred, the Royal Melbourne Hospital and the Royal Children's Hospital following the introduction of the Guidelines.

Attachment 1 - Adult Triage (PDF File 80KB)

Attachment 2 - PAED Triage (PDF File 83KB)

Victorian Trauma Services (PDF File 14KB)

Shane Solomon
Executive Director
Metropolitan Health & Aged Care Services