Guideline Development


The Major Trauma Education Project has been established by the Victorian State Trauma System to deliver a trauma-focussed sustainable state-wide educational system for clinical staff (doctors, nurses, paramedics) across Victoria.

The project is managed by Adult Retrieval Victoria within its scope as a state-wide provider of coordinated, systematised clinical advice, retrieval and information management.

Guidelines have been developed to support awareness of key aspects of the trauma system, early trauma care, specialist trauma management as well as retrieval activation and intervention. The audience for these guidelines and the educational material is primarily clinical staff in non-major trauma service settings; however the guidelines (particularly those which address process) are applicable to the entire system.

Each guideline contains supportive referencing and linkage to relevant materials and is reviewed using the AGREEII instrument for assessment of guideline development methodology. Strategies for guideline implementation can be found on the website including support material.


ARV provides a project management and support staff to research and develop guidelines, learning modules, moderated tutorials and educational material, coordinate consultation and feedback, and build and deploy the web-based components of Trauma Victoria. Staff backgrounds are from the Intensive Care Unit, Emergency department and Ambulance Victoria, particularly Intensive Care Paramedics. Staff have a range of clinical, educational and retrieval based experience. Oversight is provided by the Director of ARV. Together with this, ARV personnel and an extensive physician network was utilised to provide consultation, input and oversight of the guideline development.


Initial draft format was prepared through reference to standard authoritative information; evidence based material, as well as publications from peak bodies. The input from expert contributors with extensive experience and knowledge in the field of trauma management was sought during the consultation period. The expert review group consisted of representatives involved in trauma care / management in Victoria from both the Metropolitan & Regional/ Rural sectors as well as from specialist sub groups:

  • Department of Health and Human Services Victoria
  • Trauma System Advisory Committee (TSAC)
  • Major Trauma Services
  • Metropolitan Trauma Services
  • Regional Trauma Services
  • Adult Retrieval Victoria (ARV)
  • Victorian State Trauma Outcomes Registry and Monitoring (VSTORM)
  • Safer Care Victoria (SCV)

Once the guidelines had been reviewed by the expert sponsor, revisions were made in accordance with their recommendations.


The guideline development group was chosen by the department of health and human services for the knowledge and expertise they bring to the forefront through their experience in a chosen specialist field. The guideline development group consisted of representatives involved in trauma care / management throughout Victoria from both the Metropolitan & Regional/ Rural sectors as well as from specialist sub groups to include:

  • Major Trauma Services
  • Metropolitan Trauma Services
  • Regional Trauma Services
  • Primary Care Services
  • Urgent Care Services
  • Adult Retrieval Victoria (ARV)
  • Department of Health and Human Services Victoria
  • Ambulance Victoria (AV)

The group would meet on a regular basis in order to guide the review of the previous guidelines and the development of the new guidelines. Feedback obtained throughout the evaluation process was implemented into the guidelines.


Consultation with Trauma Victoria guideline and educational module users was sought in the early stages of the review to seek opinions regarding the development of the content of new guidelines and applicability to users.

Experts in the field of trauma management were initially chosen to review the development of the new guidelines. Topic experts were given a timeframe to review the guideline for content and readability and provide feedback to the project team. Content of the feedback was then reviewed and implemented by the ARV project team.

Consensus between current guidelines in use at Major Trauma Services and the Trauma Victoria Guidelines was established.

Once the revisions were complete the next step in the process was to distribute the draft guidelines to the STC and to clarify any areas of contention.


TSAC provides advice to the Minister for Health and the Department of Health and Human Services on the Victorian State Trauma System by identifying systemic issues and exploring opportunities for improvement. The STC is made up of a range of health service experts with proven experience in trauma management and system operations. They have been involved with the development of the guidelines since its inception and have completed the final sign off on the content of the guidelines post revision.


The guidelines to support trauma services have been designed to maintain awareness of current practices in the management of trauma. Essential to this is the sourcing and review of literature utilised and in the enhancement of guideline acceptability.

Integral to the development of an evidence based guideline series is the review of literature in current trauma management by health services. Project staff undertook a rapid structured literature review (RSLR) to identify key publications, reports and papers that should be utilised in the review of guidelines based on the RoTES Report of 1999 and the development of supportive educational documents for end users.

The RSLR format was utilised for some it its key advantages, namely;

  • Capability to advance short timeframe for research
  • Reduced budget impact to the project
  • Reduced liability on project resources

The inclusion criterion for relevant research information was;

  • English language
  • databases accessed; CINAHL, Medline/PubMed and Ovid.
  • Published within the last 10 years

Project personnel utilised publications from peak governing bodies recommended by topic experts. In addition to database explorations, staff also undertook searching of the reference lists of identified relevant publications to expand the volume of significant documents.

Exclusion criteria were deliberately pliant, in that documents of significance were not excluded purely on date of publication, where significant clinical information was identified in articles which were extensively cited by other authors.

Exclusion criteria included articles that were;

  • not available in full and only available as a summary
  • fee-for-product publications-accessibility was an issue with those agencies which charged a fee to view each review
  • English language summaries of foreign language papers
  • produced only in a language other than English