Inter-hospital transfer to a major trauma service (MTS) should be initiated soon after arriving at the primary hospital in order to reduce delaying definitive care. Major trauma patients who receive definitive care in an MTS have reduced morbidity and mortality. The Victorian State Trauma System aims to ensure that as many major trauma patients as possible receive their definitive care at an MTS.
For a patient who meets the major trauma transfer criteria, Adult Retrieval Victoria (ARV) or Paediatric Infant Perinatal Emergency Retrieval (PIPER) should be contacted within 60 minutes of their arrival at hospital. Once initial notification of the trauma patient has been received, the retrieval service will make available a coordination consultant with trauma expertise for advice regarding clinical management and/or the need for transfer. A multiparty teleconference between clinicians and facilities will be arranged as required.
Major trauma requiring an inter-hospital transfer can be recognised by: certain vital sign markers; the presence of a specific physiological or anatomical injury; deterioration associated with a high-risk mechanism of injury; or being a high-risk patient [i]. There are also guidelines, which aim to guide and support early management and transfer to an MTS for specific injuries including spinal trauma, burns, traumatic brain injury, obstetric and paediatric trauma. These guidelines have been developed in collaboration with experts in each of the relevant fields, has been assessed using the AGREE methodology for guideline development and is auspiced by the Victorian State Trauma Committee.
Clinical emphasis points
Early identification of major trauma criteria requiring inter-hospital transfer should be achieved using the defined triage guidelines.
Early activation of the retrieval and transfer system should take place.
All inter-hospital transfer of adult major trauma patients (≥16yrs) should be referred via ARV (1300 368661).
All inter-hospital transfer of paediatric major trauma patients (<16yrs) should be referred via PIPER (1300 137650).