Introduction


Victorian hospitals treat more than 3,000 major trauma patients each year, and this number is increasing by 5% per annum, with 80% being managed at an appropriately designated trauma service. Of these, 40% of patients meet major trauma criteria requiring an intensive care admission, and three-quarters of these patients are mechanically ventilated.2
The majority of trauma in Victoria is predominantly blunt trauma. Falls, motor vehicle accidents, motorbike accidents, pedestrian impacts and incidents involving pedal cyclists are the most common mechanisms of injury.
In recent years there has been an increase in the number of major trauma patients aged over 65 years. This represents approximately one-third of all major trauma cases. The incidence of falls less than 1m is rising in this age group, with head injuries being the most common serious injury sustained in this demographic.3 The annual incidence rate of paediatric major trauma patients (aged younger than 16 years) remains low, at 13 per 100.000 in 2015-2016.
Overall, the percentage of major trauma patients receiving definitive care at an MTS, the Austin for spinal, or an MNS transported directly from the scene of injury, home or GP has decreased from 70% in 2011-2012 to 65% in 2015-2016.2  This means that around one in threemajor trauma patients will be managed initially at a peripheral hospital or health service.
 

Patients who meet major trauma criteria outlined in the Major Trauma Advice and Inter-hospital Transfer Guidelines should be stabilised at the referral health service and discussed with ARV within 60 minutes of arrival to arrange for transfer to a major trauma service. ARV provides clinical advice on the management and stabilisation of major trauma patients and coordinates subsequent retrieval and transfer if required.

Transport accidents are one of the most common causes of injury
Image used with permission from Department of Health, Victoria
The Review of Trauma and Emergency Services (RoTES) report (19994) underpins much of the Victorian State Trauma System and specified the following in response to the general team approach to early management of major trauma patients:
“The multidisciplinary trauma team approach to trauma resuscitation and stabilisation is one recommended by several bodies (ACS, 1993; NRTAC, 1993). All hospitals designated to receive trauma patients must have a formal organised response to the initial reception and management of trauma patients. The establishment of a trauma team is crucial to this. Clarifying the roles and responsibilities of each member of the team enables an optimally coordinated approach during resuscitation, when many tasks must be carried out simultaneously. Trauma team members should comprise the most skilled clinicians available to fulfil each roll within the team. Clinicians should, therefore be sourced from throughout the hospital.”
On occasions paramedics may play an active role in the trauma team within rural or regional facilities where availability of experienced and skilled hospital staff may be limited.