Key Messages

In the 16 years since the introduction of the Victorian State Trauma System (VSTS), preventable death and disability from major trauma has reduced significantly.1 Today, the VSTS is considered a world leader in integrated trauma systems, with several international jurisdictions implementing trauma systems based on the VSTS model.2
The VSTS is co-funded by the Department of Health and Human Services and the Transport Accident Commission to ensure major trauma patients are managed optimally.
The objective of the VSTS is to reduce preventable mortality and improve the outcomes of severely injured patients by matching their needs to an appropriate level of treatment in a safe and timely manner.
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 (MNS) for older patients with isolated head injuries).
This guideline is developed for all clinical staff involved in the care of trauma patients in Victoria. It is intended for use by frontline clinical staff that provide early care for major trauma patients; those working directly at the Major Trauma Service (MTS) as well as those working outside of a MTS.
These guidelines provide the user with accessible resources to effectively and confidently provide early care for critically injured patients. They provide up-to-date information for frontline healthcare clinicians. The guideline has followed the AGREE II methodology for guideline development and is under the auspice of the Victorian State Trauma Committee (VSTC).3
There is clear evidence that the VSTS has been highly effective in improving the clinical management and outcomes of major trauma patients, with continued improvements achieved.
 
Key elements of the VSTS that underpin its success include:

  • Coordination of pre-hospital and acute care services.
  • Designation of two adult and one paediatric hospital as MTS hospitals, with all other potential trauma-receiving hospitals assigned a trauma designation according to clinical capacity.
  • Defined triage guidelines for ambulance transportation of patients to MTS hospitals.
  • Statewide system organisation and management of major trauma response through Adult Retrieval Victoria (ARV) and the Paediatric Infant Perinatal Emergency Retrieval Service (PIPER) for patients less than 16 years.
  • A ministerial committee and subcommittees to oversee the trauma system and identify opportunities for continuous improvement.
      

Clinical emphasis points

  • An integrated and inclusive trauma system, the VSTS commenced in 2000.
  • The VSTS delivers a systemic clinical pathway for efficiently managing major trauma patients.
  • The treatment of critically ill patients with multiple injuries requires a multidisciplinary, coordinated and integrated system of trauma care.
  • Integrated trauma care systems have been shown to reduce preventable deaths.
  • The introduction of the VSTS has been associated with a significant reduction in mortality and morbidity from major trauma.
  • The designation of all 140 potential trauma-receiving hospitals reflects the clinical capabilities of each hospital.
  • High compliance with major trauma guidelines and protocols ensures the right patient to the right level of care in the shortest time.
  • The MTS hospitals are designed to provide specialised intensive care with the necessary multidisciplinary teams to manage critically injured patients.
  • Clinical evidence indicates that patients with major trauma achieve better outcomes when definitive care is provided at an MTS or a specialist trauma service (the Austin Hospital for spinal cord trauma and the Metropolitan Neurosurgical Services (MNS) for older patients with isolated head injuries). The proportion of patients transferred directly to an MTS hospital or specialist trauma services has risen significantly since the VSTS began.
  • Appropriate inter-hospital transfers are now consistently around 90 per cent and above.
  • ARV or PIPER (for paediatric patients) is the first point of call to initiate retrieval and transfer of trauma patients.
  • The VSTS is enhanced and strengthened by a state-wide trauma education system that provides clinical and system education on the early management of major trauma patients.

    The success of the VSTS and its impact on patient outcomes is a result of the work of all staff providing care to major trauma patients at every stage of the patient journey.

    Good early trauma care, appropriate and timely transfer and best practice in definitive care continue to improve outcomes for Victorian victims of major trauma.

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