The objective of pre-hospital triage is to reduce preventable death and permanent disability and to improve patient outcomes by matching the needs of the injured patient to an appropriate level of care in a safe and timely manner.
The triage decision in the pre hospital setting is based on anatomic, physiologic and high mechanism risk criteria, available resources, and time and distance factors to hospital[i]. The level of care available at the destination facility has a significant impact on outcome, therefore access to the highest level of trauma service possible within logistic and safety parameters is desirable. The VSTS aims to ensure that as many major trauma patients as possible receive their definitive care at a major trauma service (MTS) or equivalent specialist trauma service (the Austin Hospital for spinal cord trauma and the Metropolitan Neurological services for older patients with isolated head injuries). Non-major trauma patients, once identified, should remain in a local facility where their care can best be managed inclusive of family and local support services.
Overall, there has been an increase in the percentage of major trauma patients transported directly to the hospital of definitive care from the scene of injury, home or general practitioner (GP), from 65.9 per cent in 2005−06 to 68.9 per cent in 2011−12[ii]. This change indicates a significant improvement in pre-hospital triage and transportation processes.
An aim of pre-hospital triage is to optimise the identification of major trauma patients and to minimise the over-triage of non-major trauma patients.
Major trauma in the pre-hospital setting in Victoria can be identified when there is a minimum of one out of three criteria present. These are: the presence of abnormal vital signs; the presence of an assumed or actual anatomic injury; or the existence of a high-risk mechanism of injury in at-risk patients.
These guidelines provide the user with accessible resources to effectively and confidently provide early care for critically injured patients. The guideline is evidence based, has followed the AGREE methodology for guideline development and is auspiced by the Victorian State Trauma Committee.
Clinical emphasis points
Victoria’s trauma system is integrated and inclusive, with system guidelines directing responders and hospitals as to the most appropriate destination facility for the patient.
Expert scene assessment and initial pre-hospital management of life-threatening injuries is essential.
Major trauma criteria using the defined triage guidelines must be identified.
Initial dispatch to the scene via either road or air must be well coordinated.
Two adult and one paediatric hospital are designated as MTS hospitals, with potential trauma-receiving hospitals assigned a trauma designation.