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- Victorian State Trauma System

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  • Key Messages
    • Clinical emphasis points
  • Rapid Reference Guideline
    • Introduction
      • Early Activation
        • Ambulance handover
        • Reception and resuscitation
      • Primary Survey
        • Airway with cervical spine protection
        •  Breathing and ventilation
        •  Circulation with haemorrhage control
        •  Disability
        •  Exposure and environment
      • Secondary Survey
        • History
        • Head-to-toe examination
        • Head and face
        • Neck
        • Chest
        • Abdomen
        • Limbs
        • Back
        • Buttocks and perineum
        • Genitalia
      • Planning and Communication
        • Early Management
          • Airway management
          • Fluid resuscitation
          • Analgesia
          • Fractures and dislocations
          • Prevent hypothermia
          • In-dwelling catheter
          • Monitoring
          • Glasgow Coma Scale
          • Pathology tests
          • X-ray or FAST scan
          • Naso/orogastric tube (N/OGT)
          • Wound care
          • Tetanus immunisation
          • Antibiotics
          • Reassess
        • Retrieval and Transfer
          • References

            Rapid Reference Guideline

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            • Trauma System Guidelines
            • Victorian Trauma System
            • Pre-Hospital Triage
            • Inter-Hospital Transfer
            • Preparation for Retrieval
            • Teamwork and Communication
            • Specialist Clinical Guidelines
            • Early Trauma Care
            • Burns
            • Obstetric Trauma
            • The Deteriorating Trauma Patient
            • Traumatic Brain Injury
            • Spinal Trauma
            • Anticoagulation Trauma
            • Paediatric Trauma
            • Cardiac Arrest in Trauma
            • Imaging in Trauma
            • Older Person Trauma
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            • ©2023 Victorian Department of Health
            • Last Update: 20 January 2023
            • Trauma System Guidelines
              • Victorian Trauma System
                • Key Messages
                  • Clinical emphasis points
                • Introduction
                  • Definition of Major Trauma
                    • Key features of the Victorian State Trauma System
                      • Victorian State Trauma System Outcomes
                        • Resources
                          • References
                          • Pre-Hospital Triage
                            • Key Messages
                              • Clinical emphasis points
                            • Rapid Reference Guide
                              • Identification of Potential Major Trauma
                                •  Vital signs
                                •  Injuries found or suspected
                                • Isolated head injury in older people
                                •  High-risk criteria
                              • On Scene
                                • Scene Time
                                • ARV Notification
                              • Transport Time
                                • Persisting hypovolaemic shock
                              • References
                              • Inter-Hospital Transfer
                                • Key Messages
                                  • Clinical emphasis points
                                • Rapid Reference Guideline
                                  • Identification of Potential Major Trauma
                                    •  Vital signs
                                    •  Injuries found or suspected
                                    • Specialised trauma transfer indications
                                    •  High-risk criteria
                                  • Deterioration
                                    • Contact Retrieval Service
                                      • Telemedicine
                                      • Pre-transport communication and coordination
                                    • Retrieval and transfer
                                      • Ensuring patient readiness for transfer
                                    • References
                                    • Preparation for Retrieval
                                      • Key Messages
                                        • Clinical emphasis points 
                                      • Rapid Reference Guide
                                        • Introduction
                                          • Retrieval Coordination
                                            • Choice of Transport Vehicle
                                              • Process of Transfer
                                                • Pre-transport communication and coordination
                                                • Ensuring patient readiness for transfer
                                              • Patient Preparation
                                                •  Airway
                                                •  Breathing
                                                •  Circulation and C-spine
                                                •  Documentation
                                                •  Alert
                                                • Other
                                              • References
                                              • Teamwork and Communication
                                                • Key Messages
                                                  • Clinical emphasis points
                                                • Key attributes of an effective team
                                                  • Trauma team structure
                                                    • Trauma team positions
                                                    • Modified trauma team positions
                                                  • The role of the team leader
                                                    • What is situational awareness?
                                                  • Effective Communication
                                                    • What is a shared mental model?
                                                    • Briefing the team
                                                    • Tacit vs explicit communication
                                                    • Closed-loop communication
                                                    • Handover
                                                    • Remote support and communication
                                                  • Dealing with issues
                                                    • Graded assertiveness
                                                    • Five-step advocacy
                                                  • Trauma Team Training
                                                    • References
                                                  • Specialist Cinical Guidelines
                                                    • Early Trauma Care
                                                      • Key Messages
                                                        • Clinical emphasis points
                                                      • Rapid Reference Guideline
                                                        • Introduction
                                                          • Early Activation
                                                            • Ambulance handover
                                                            • Reception and resuscitation
                                                          • Primary Survey
                                                            • Airway with cervical spine protection
                                                            •  Breathing and ventilation
                                                            •  Circulation with haemorrhage control
                                                            •  Disability
                                                            •  Exposure and environment
                                                          • Secondary Survey
                                                            • History
                                                            • Head-to-toe examination
                                                            • Head and face
                                                            • Neck
                                                            • Chest
                                                            • Abdomen
                                                            • Limbs
                                                            • Back
                                                            • Buttocks and perineum
                                                            • Genitalia
                                                          • Planning and Communication
                                                            • Early Management
                                                              • Airway management
                                                              • Fluid resuscitation
                                                              • Analgesia
                                                              • Fractures and dislocations
                                                              • Prevent hypothermia
                                                              • In-dwelling catheter
                                                              • Monitoring
                                                              • Glasgow Coma Scale
                                                              • Pathology tests
                                                              • X-ray or FAST scan
                                                              • Naso/orogastric tube (N/OGT)
                                                              • Wound care
                                                              • Tetanus immunisation
                                                              • Antibiotics
                                                              • Reassess
                                                            • Retrieval and Transfer
                                                              • References
                                                              • Burns
                                                                • Key Messages
                                                                  • Clinical emphasis points:
                                                                • Rapid Reference Guideline
                                                                  • Introduction
                                                                    • Early Activation
                                                                      • Primary Survey
                                                                        •  Airway with cervical spine protection
                                                                        •  Breathing and ventilation
                                                                        •  Circulation with haemorrhage control
                                                                        •  Disability: neurological status
                                                                        •  Exposure/environmental control
                                                                      • Secondary Survey
                                                                        • History
                                                                        • Head-to-toe examination
                                                                        • Measuring burns
                                                                        • Head-to-toe examination
                                                                      • Planning and Communication
                                                                        • Early Management
                                                                          • Airway management
                                                                          • Fluid resuscitation
                                                                          • Compartment Syndrome
                                                                          • Analgesia
                                                                          • Wound care
                                                                          • Minimise heat loss
                                                                          • In-dwelling catheter
                                                                          • Monitoring
                                                                          • Glasgow Coma Scale
                                                                          • Pathology tests
                                                                          • X-ray/FAST scan
                                                                          • Naso/orogastric tube (N/OGT)
                                                                          • Tetanus immunisation
                                                                          • Antibiotics
                                                                          • Reassess
                                                                        • Retrieval and Transfer
                                                                          • References
                                                                          • Obstetric Trauma
                                                                            • Key Messages
                                                                              •  Clinical emphasis points
                                                                            • Rapid Reference Guideline
                                                                              • Introduction
                                                                                • Changes in pregnancy
                                                                                • Complications associated with trauma
                                                                              • Early Activation
                                                                                • Primary Survey
                                                                                  •  Airway with cervical spine protection
                                                                                  •  Breathing and ventilation
                                                                                  •  Circulation with haemorrhage control
                                                                                  •  Disability: neurological status
                                                                                  •  Exposure/environmental control
                                                                                • Secondary Survey
                                                                                  • History
                                                                                  • Head-to-toe examination
                                                                                • Planning and Communication
                                                                                  • Pre-hospital triage
                                                                                  • Inter-hospital transfer
                                                                                • Early Management
                                                                                  • Patient positioning
                                                                                  • Airway management
                                                                                  • Radiology
                                                                                  • Pathology tests
                                                                                  • Preventing hypothermia
                                                                                  • Analgesia and antiemetics
                                                                                  • Sedation
                                                                                  • Monitoring
                                                                                  • Wound care
                                                                                  • In-dwelling catheter
                                                                                  • Nasogastric tube
                                                                                  • Tetanus prophylaxis
                                                                                  • Antibiotics
                                                                                  • Cardiac arrest
                                                                                  • Blood matters
                                                                                  • Reassess
                                                                                • Retrieval and Transfer
                                                                                  • References
                                                                                  • The Deteriorating Trauma Patient
                                                                                    • Key Messages
                                                                                      • Clinical emphasis points
                                                                                    • Rapid Reference Guideline
                                                                                      • Introduction
                                                                                        • Deteriorating trauma patients
                                                                                        • Track and Trigger
                                                                                      • Clinical Observation of Major Trauma Patient
                                                                                        • Recognising and responding to clinical deterioration
                                                                                      • Team Role in Recognising Deterioration
                                                                                        • ABCDEFG for deteriorating patients
                                                                                      • Early Activation or Consultation
                                                                                        • Further Information
                                                                                          • References
                                                                                          • Traumatic Brain Injury
                                                                                            • Key Messages
                                                                                              • Clinical emphasis points
                                                                                            • Rapid Reference Guideline
                                                                                              • Introduction
                                                                                                • Early Activation
                                                                                                  • Primary Survey
                                                                                                    •  Airway with cervical spine protection
                                                                                                    •  Breathing and ventilation
                                                                                                    •  Circulation with haemorrhage control
                                                                                                    •  Disability: neurological status
                                                                                                    •  Exposure/environmental control
                                                                                                  • Secondary Survey
                                                                                                    • History
                                                                                                    • Neurological assessment
                                                                                                    • Head-to-toe examination
                                                                                                  • Planning and Communication
                                                                                                    • Indications for ARV consultation and/or transfer to a major trauma service
                                                                                                  • Early Management
                                                                                                    • Airway management
                                                                                                    • Imaging
                                                                                                    • The intoxicated patient with head trauma
                                                                                                    • Anticoagulation and head trauma
                                                                                                    • Patient positioning
                                                                                                    • Seizure Prophylaxis
                                                                                                    • Pathology tests
                                                                                                    • Thermoregulation
                                                                                                    • Analgesia
                                                                                                    • Sedation
                                                                                                    • Monitoring
                                                                                                    • Wound care
                                                                                                    • In-dwelling catheter
                                                                                                    • Nasogastric tube
                                                                                                    • Tetanus immunisation
                                                                                                    • Antibiotics
                                                                                                    • Steroids
                                                                                                    • Reassess
                                                                                                  • The Rapidly Deteriorating TBI Patient
                                                                                                    • Additional management points
                                                                                                    • Hyperventilation
                                                                                                    • Osmotherapy
                                                                                                    • Burr hole evacuation
                                                                                                  • Retrieval and Transfer
                                                                                                    • References
                                                                                                    • Spinal Trauma
                                                                                                      • Key Messages
                                                                                                        • Clinical emphasis points
                                                                                                      • Rapid Reference Guideline
                                                                                                        • Introduction
                                                                                                          • Early Activation
                                                                                                            • Early rapid neurological assessment
                                                                                                              • Primary Survey
                                                                                                                •  Airway with cervical spine protection
                                                                                                                •  Breathing and ventilation
                                                                                                                •  Circulation with haemorrhage control
                                                                                                                •  Disability: neurological status
                                                                                                                •  Exposure/environmental control
                                                                                                              • Secondary Survey
                                                                                                                • History
                                                                                                                • Head-to-toe examination
                                                                                                                • Neck
                                                                                                                • Chest
                                                                                                                • Abdomen
                                                                                                                • Limbs
                                                                                                                • Back
                                                                                                                • Buttocks and perineum
                                                                                                                • Genitalia
                                                                                                              • Planning and Communication
                                                                                                                • Early Management
                                                                                                                  • Airway management
                                                                                                                  • Fluid resuscitation
                                                                                                                  • Monitoring
                                                                                                                  • Medical imaging
                                                                                                                  • Wound care
                                                                                                                  • Pressure area care
                                                                                                                  • Analgesia
                                                                                                                  • Prevent hypothermia
                                                                                                                  • Glasgow Coma Scale
                                                                                                                  • Pathology
                                                                                                                  • In-dwelling catheter
                                                                                                                  • Nasogastric tube
                                                                                                                  • Antibiotics
                                                                                                                  • Reassess
                                                                                                                  • Other
                                                                                                                • Retrieval and Transfer
                                                                                                                  • Isolated spinal cord injury
                                                                                                                  • Potential multi-trauma
                                                                                                                • References
                                                                                                                • Thoracic Trauma
                                                                                                                  • Key Messages
                                                                                                                    • Clinical Emphasis Points
                                                                                                                  • Rapid Reference Guideline
                                                                                                                    • Introduction
                                                                                                                      • Immediately life threatening injuries
                                                                                                                        • Tension pneumothorax
                                                                                                                        • Massive Haemothorax
                                                                                                                        • Cardiac Tamponade
                                                                                                                        • Open pneumothorax
                                                                                                                        • Flail Chest & Pulmonary Contusions
                                                                                                                        • Major tracheobronchial injuries – larynx/ trachea
                                                                                                                      • Early activation
                                                                                                                        • Primary survey
                                                                                                                          • Airway with cervical spine protection 
                                                                                                                          • Breathing and Ventilation
                                                                                                                          • Circulation with haemorrhage control
                                                                                                                          • Disability: Neurological status
                                                                                                                          • Exposure and environmental control
                                                                                                                          • Investigations
                                                                                                                          • Analgesia
                                                                                                                        • Secondary survey
                                                                                                                          • History
                                                                                                                          • Head-to-toe examination
                                                                                                                        • Planning and Communication
                                                                                                                          • Early management
                                                                                                                            • Airway management
                                                                                                                            • Fluid resuscitation
                                                                                                                            • Monitor
                                                                                                                            • Administer
                                                                                                                            • Wound Care
                                                                                                                          • Retrieval and Transfer
                                                                                                                            • References
                                                                                                                            • Anticoagulation in Trauma
                                                                                                                              • Key Messages
                                                                                                                                • Clinical Emphasis Points
                                                                                                                              • Rapid Reference Guideline
                                                                                                                                • Introduction
                                                                                                                                  • Types of Oral Anticoagulation
                                                                                                                                    • Vitamin K Antagonists
                                                                                                                                    • Direct (or Novel) Oral Anticoagulants (DOAC’s/NOAC’s)
                                                                                                                                    • Half-life and Elimination
                                                                                                                                  • Monitoring and Pathology Tests
                                                                                                                                    • Interpretation of coagulation screen
                                                                                                                                  • Management Agents
                                                                                                                                    • Transfusion support
                                                                                                                                    • Anti-fibrinolytic agents
                                                                                                                                    • Pro-haemostatic agents
                                                                                                                                    • Reversal agents
                                                                                                                                  • Early Management
                                                                                                                                    • Head Injury and Oral Anticoagulants
                                                                                                                                      • Retrieval and Transfer
                                                                                                                                        • References
                                                                                                                                        • Paediatric Trauma
                                                                                                                                          • Key Messages
                                                                                                                                            • Clinical emphasis points
                                                                                                                                          • Rapid Reference Guideline
                                                                                                                                            • Introduction
                                                                                                                                              • Early Activation
                                                                                                                                                • Primary Survey and Early Management
                                                                                                                                                  •  Airway with cervical spine protection
                                                                                                                                                  •  Breathing and ventilation
                                                                                                                                                  •  Circulation with haemorrhage control
                                                                                                                                                  •  Disability: neurological status
                                                                                                                                                  •  Exposure/environmental control
                                                                                                                                                • Secondary Survey
                                                                                                                                                  • History
                                                                                                                                                  • Neurological exam
                                                                                                                                                  • Head-to-toe examination
                                                                                                                                                • Additional points for early management
                                                                                                                                                  • Trauma imaging
                                                                                                                                                  • Analgesia
                                                                                                                                                  • In-dwelling catheter
                                                                                                                                                  • Orogastric tube (OGT)
                                                                                                                                                  • Antibiotics
                                                                                                                                                  • Tetanus immunisation
                                                                                                                                                  • Reassess
                                                                                                                                                • Planning and Communication
                                                                                                                                                  • Paediatric Burns Sub Guideline
                                                                                                                                                    • Overview
                                                                                                                                                    • Assessment
                                                                                                                                                    • Management
                                                                                                                                                  • Paediatric Spinal Sub Guideline
                                                                                                                                                    • Overview
                                                                                                                                                    • Assessment
                                                                                                                                                    • Management
                                                                                                                                                  • Paediatric Traumatic Brain Injury Sub-Guideline
                                                                                                                                                    • Overview
                                                                                                                                                    • Advice and Retrieval
                                                                                                                                                    • Primary Survey Assessment
                                                                                                                                                    • Management
                                                                                                                                                    • CT scanning
                                                                                                                                                  • Retrieval and Transfer
                                                                                                                                                    • References
                                                                                                                                                    • Abdominal Trauma
                                                                                                                                                      • Key Messages
                                                                                                                                                        • Clinical Emphasis Points
                                                                                                                                                      • Rapid Reference Guideline
                                                                                                                                                        • Introduction
                                                                                                                                                          • Blunt abdominal trauma
                                                                                                                                                          • Angioembolisation
                                                                                                                                                          • Penetrating abdominal trauma
                                                                                                                                                          • Solid organ versus hollow viscus injury
                                                                                                                                                        • Early Activation
                                                                                                                                                          • Primary Survey
                                                                                                                                                            • Airway with cervical spine protection 
                                                                                                                                                            • Breathing and ventilation 
                                                                                                                                                            • Circulation with haemorrhage control 
                                                                                                                                                            • Disability: Neurological status 
                                                                                                                                                            • Exposure and environment 
                                                                                                                                                            • Emergency Laparotomy
                                                                                                                                                            • Imaging
                                                                                                                                                          • Secondary Survey
                                                                                                                                                            • History
                                                                                                                                                            • Head-to-toe examination
                                                                                                                                                          • Planning and Communication
                                                                                                                                                            • Early Management
                                                                                                                                                              • Haemostatic resuscitation
                                                                                                                                                              • Permissive hypotension
                                                                                                                                                              • Damage control surgery
                                                                                                                                                              • Naso/orogastric tube (N/OGT)
                                                                                                                                                              • Urinalysis
                                                                                                                                                              • Imaging
                                                                                                                                                              • Blunt trauma
                                                                                                                                                              • Penetrating wounds
                                                                                                                                                              • Laboratory tests
                                                                                                                                                              • Fluid resuscitation
                                                                                                                                                              • Analgesia
                                                                                                                                                              • Prevent hypothermia
                                                                                                                                                              • Monitoring
                                                                                                                                                              • Glasgow Coma Scale
                                                                                                                                                              • Tetanus immunisation
                                                                                                                                                              • Antibiotics
                                                                                                                                                              • Reassess
                                                                                                                                                            • Retrieval and Transfer
                                                                                                                                                              • References
                                                                                                                                                              • Traumatic Cardiac Arrest
                                                                                                                                                                • Key Messages
                                                                                                                                                                  • Clinical Emphasis Points:
                                                                                                                                                                • Rapid Reference Guideline
                                                                                                                                                                  • Introduction
                                                                                                                                                                    • Pre-hospital considerations
                                                                                                                                                                      • Management
                                                                                                                                                                        • Haemorrhage
                                                                                                                                                                        • Tension pneumothorax
                                                                                                                                                                        • Airway obstruction
                                                                                                                                                                      • Conventional BLS and ALS considerations
                                                                                                                                                                        • External chest compressions & ventilation
                                                                                                                                                                        • Adrenaline
                                                                                                                                                                        • Defibrillation
                                                                                                                                                                        • Reversible causes
                                                                                                                                                                      • Resuscitation procedures
                                                                                                                                                                        • Ultrasonography
                                                                                                                                                                        • Pericardiocentesis
                                                                                                                                                                        • Resuscitative Thoracotomy
                                                                                                                                                                      • Resource Limited Facility
                                                                                                                                                                        • Return of Spontaneous Circulation ROSC
                                                                                                                                                                          • Damage control resuscitation
                                                                                                                                                                        • Endpoint to Resuscitation
                                                                                                                                                                          • Debriefing
                                                                                                                                                                            • Paediatric Considerations
                                                                                                                                                                              • References
                                                                                                                                                                              • Imaging in Trauma
                                                                                                                                                                                • Key Messages
                                                                                                                                                                                  • Clinical Emphasis Points:
                                                                                                                                                                                • Introduction
                                                                                                                                                                                  • Modalities of Imaging
                                                                                                                                                                                    • Plain film X-rays
                                                                                                                                                                                    • Ultrasound
                                                                                                                                                                                    • CT scanning
                                                                                                                                                                                    • MRI
                                                                                                                                                                                  • Early Activation
                                                                                                                                                                                    • Indications for Imaging
                                                                                                                                                                                      • Head
                                                                                                                                                                                      • Spine
                                                                                                                                                                                      • Chest
                                                                                                                                                                                      • Abdomen
                                                                                                                                                                                    • Radiation and contrast considerations
                                                                                                                                                                                      • Paediatric considerations
                                                                                                                                                                                        • Trauma imaging
                                                                                                                                                                                      • Education Modules
                                                                                                                                                                                        • Adult
                                                                                                                                                                                        • Paediatric
                                                                                                                                                                                      • References
                                                                                                                                                                                      • Older Person Trauma
                                                                                                                                                                                        • Key Messages
                                                                                                                                                                                          • Clinical Emphasis Points
                                                                                                                                                                                        • Rapid Reference Guideline
                                                                                                                                                                                          • Introduction
                                                                                                                                                                                            • Older person Anatomy and Physiology
                                                                                                                                                                                            • Mechanism of Injury
                                                                                                                                                                                          • Early Activation
                                                                                                                                                                                            • Primary Survey
                                                                                                                                                                                              • Airway with cervical spine protection 
                                                                                                                                                                                              • Breathing and ventilation 
                                                                                                                                                                                              • Circulation with haemorrhage control 
                                                                                                                                                                                              • Disability: neurological status 
                                                                                                                                                                                              • Exposure/Environmental Control 
                                                                                                                                                                                            • Secondary Survey
                                                                                                                                                                                              • History
                                                                                                                                                                                              • Head-to-toe examination
                                                                                                                                                                                            • Planning and Communication
                                                                                                                                                                                              • Limitation of Treatment Orders
                                                                                                                                                                                                • Early Management
                                                                                                                                                                                                  • Diagnostic imaging
                                                                                                                                                                                                  • ECG
                                                                                                                                                                                                  • Optimising oxygenation
                                                                                                                                                                                                  • Fluid resuscitation
                                                                                                                                                                                                  • Insert
                                                                                                                                                                                                  • Monitor
                                                                                                                                                                                                  • Administer
                                                                                                                                                                                                  • Monitor blood results
                                                                                                                                                                                                  • Wound Care
                                                                                                                                                                                                  • Psychological health
                                                                                                                                                                                                • Transfer and Retrieval
                                                                                                                                                                                                  • References
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