Hospital Circulars

Hospital Circular 01/2004

Date Issued: 12 January 2004

Contact: Alison McMillan, Clinical Governance Unit. Tel (03) 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 came into effect on 15 July 2002 and were updated on 14 October 2002.

This Circular supersedes Hospital Circular 29 /2002.

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. Revised Rural and Regional Hospital Designation List

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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.
• Early data is suggestive that these guidelines have been successful

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 Hospital 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.

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 Health 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):

• Melbourne Health: Royal Melbourne Hospital; and
• The Alfred.

The following hospital is the highest level of paediatric trauma service and is designataed Major Trauma Service (MTS)

• Royal Children's Hospital

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 Hospital
• Eastern Health: Box Hill Hospital
• Southern Health: Monash Medical Centre, Clayton; Dandenong Hospital
• Peninsula Health: Frankston Hospital,
• Northern Health: The Northern Hospital

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

• Eastern Health: Maroondah Hospital
• Sisters Of Charity Health Service Melbourne: St Vincent's Hospital
• Western Health: 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):

• Peninsula Health: Rosebud Hospital
• Bayside Health: Sandringham and District Memorial Hospital
• Western health: Sunshine Hospital
• Eastern Health: The Angliss Health Services
• Mercy Public Hospitals Inc: The Mercy Hospital, Werribee
• Western Health: Williamstown Hospital
• (Private Hospitals with Emergency Departments when authorised under Hospital Circular 4/1998)

Trauma Services in regional and rural Victoria (outlined at Attachment 1) 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.

Shane Solomon
Executive Director
Metropolitan Health And Aged Care Services

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Attachment 1

BARWON SOUTH WEST REGION

Regional Trauma Service

Barwon Health - The Geelong Hospital
South West Health Care - Warrnambool
Western District Health Service - Hamilton

Urgent Care Service

Casterton Memorial Hospital
Coleraine and District Hospital
Colac Community Health Services - Colac
Hesse Rural Health Service -Winchelsea
Lorne Community Hospital
Moyne Health - Port Fairy
Portland and District Hospital
South West Health Care - Camperdown
Terang and Mortlake Health Service
Timboon and District Health Care Service
Otway Health and Community Service - Apollo Bay

Primary Care Service

Colac Community Health Services - Birregurra
South West Health Care - Lismore
Hesse Rural Health Service - Rokewood
Hesse Rural health Service - Beeac
Heywood Rural Health
Terang and Mortlake Health Service - Mortlake
Western District Health Service -Penshurst

Private Facilities

Balmoral Bush Nursing Centre
Cobden and District Health Service
Dartmoor and District Bush Nursing Centre
Merino Health Services

GIPPSLAND REGION

Regional Trauma Service

Latrobe Regional Hospital

Urgent Care Service

Bairnsdale Regional Health Service
Gippsland Southern Health Service - Leongatha
Gippsland Southern Health Service - Korumburra
Central Gippsland Health Service - Sale
Orbost Regional Health
South Gippsland Hospital - Foster
West Gippsland Health Care Group - Warragul
Wonthaggi and District Hospital
Yarram and District Health Service

Private Facilities

Warley Hospital -Cowes

Primary Care Service

Omeo District Hospital
Lakes Entrance Community Health Centre

Private Facilities

Buchan Bush Nursing Centre
Cann Valley Bush Nursing Centre
Dargo Bush Nursing Centre
Gelantipy & District Bush Nursing Centre
Heyfield Bush Nursing Hospital
Mallacoota Medical Centre
Mt Baw Baw Medical Centre
Neerim District Soldiers Memorial Hospital
Swift's Creek Bush Nursing Centre

GRAMPIANS REGION

Regional Trauma Service

Ballarat Health Services - Ballarat Base Hospital
Wimmera Health Care Group - Wimmera Base Hospital

Urgent Care Service

East Grampians Health Service - Ararat
East Wimmera Health Service - St Arnaud
Edenhope and District Memorial Hospital
Hepburn Health Service - Daylesford
Stawell District Hospital
West Wimmera Health Service - Nhil
Rural North West Health - Warracknabeal

Private Facilities

St John of God Health Care Ballarat

Primary Care Service

Beaufort and Skipton Health Service - Beaufort
Beaufort and Skipton Health Service - Skipton
Djerriwarrh Health Service - Bacchus Marsh
East Wimmera Health Service - Donald
East Wimmera Health Service - Charlton
East Wimmera Health Service - Wycheproof
East Wimmera Health Service - Birchip
Hepburn Health Service - Creswick
Rural Northwest Health - Hopetoun
Wimmera Health Care Group - Dimboola
Dunmunkle Health Service - Rupanyup
West Wimmera Health Service - Jeparit
West Wimmera Health Service - Kaniva
West Wimmera Health Service - Rainbow
Elmhurst Bush Nursing Centre
Harrow Bush Nursing Centre
Woomelang Bush Nursing Centre
Lake Bolac Bush Nursing Centre

Private Facilities

Ballan and District Soldiers' Memorial Bush Nursing Hospital
Rural Northwest Health - Beulah Pioneers' Bush Nursing Hospital

HUME REGION

Regional Trauma Service

Goulburn Valley Health (GVBH) Shepparton
Northeast Health Wangaratta
Albury Base Hospital

Urgent Care Service

Alexandra District Hospital
Alpine Health - Bright, Mt Beauty, Myrtleford
Benalla and District Memorial Hospital
Cobram District Hospital
Kilmore and District Hospital
Numurkah District Health Service
Mansfield District Hospital
Seymour District Memorial Hospital
Upper Murray Health and Community Service - Corryong
Wodonga Regional Health Service
Yarrawonga & District Service
Yea and District Memorial Hospital

Primary Care Service

Nathalia District Hospital
Tallangatta Health Service
Beechworth Health Service

Private facilities

Chiltern and District Bush Nursing Hospital
Euroa Bush Nursing Hospital
Falls Creek Medical Centre
Mt Buller Medical Centre
Mt Hotham Medical Centre
Nagambie Bush Nursing Hospital
Violet Town Bush Nursing Centre
Walwa Bush Nursing Centre
Yackandandah Bush Nursing Hospital

LODDON MALLEE

Regional Trauma Service

Bendigo Health Care Group
Mildura Base Hospital

Urgent Care Service

Cohuna District Hospital
Echuca Regional Hospital
Kerang and District Hospital
Kyabram and District Memorial Hospital
Kyneton and District Health Service
Maryborough District Health Service
Mt Alexander Hospital
Swan Hill District Hospital

Primary Care Service

Boort District Hospital
Inglewood and District Health Service
Maldon and District Health and Community Care
Mallee Track Health and Community Service
Manangatang and District Health Service
McIvor Health and Community Service
Robinvale District Hospital and Health Service
Rochester and Elmore District Hospital

Private Facilities

Dingee Bush Nursing Centre
Lockington and District Bush Nursing Centre
Pyramid Hill Bush Nursing Hospital
Sea Lake and District Health Service