Victorian State Trauma System

Major Trauma Guidelines & Education – Victorian State Trauma System

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Inter-Hospital Transfer

It is vital that patients suffering from a major trauma are identified early so they can be triaged to an appropriate level of care in a timely manner. This is essential in order to reduce preventable death and permanent disability.

Contact Retrieval Service

Adult Retrieval Victoria (ARV: 1300 36 86 61 – Adult Patients) or Paediatric Infant Perinatal Emergency Retrieval (PIPER: 1300 137 650 – child < 16 years of age) is the first point of call for:

  • Notification of the arrival of a patient who meets the major trauma inter-hospital transfer criteria.
  • Activation of a request for retrieval.
  • Clinical advice.

Major trauma patients aged 0-15 years should attend the Royal Children’s Hospital. Patients aged 16 and over should attend an adult MTS. As the age of a patient is not always known to Ambulance Victoria, and some patients will self-present to a health service, patients may receive definitive care at the first major trauma service they attend, before being transferred to an age-appropriate service when it is safe to do so.

MTS hospitals that are contacted directly by a referring hospital will refer cases to ARV or PIPER to coordinate clinical advice and transfer. ARV and PIPER coordinators can facilitate a three-way conversation between the referral health service, the accepting trauma facility, and a retrieval consultant to discuss the best, timely management of the patient.

The decision of when to transfer an unstable patient should ideally be made by the transferring and receiving clinicians in collaboration with the retrieval service (13, 14).

It is important to emphasise the necessity for consultation to clarify the need for transfer of patients who meet the major trauma transfer criteria. This will also facilitate alternate management pathways in the following circumstances:

  • The patient’s injuries are assessed as not severe enough to warrant transfer.
  • The referring hospital has the capacity to provide appropriate definitive treatment.
  • The MTS is in agreement not to transfer in a particular case.
  • Transfer from a peripheral hospital to a regional trauma service is appropriate for the needs of the patient.

Telemedicine

If telemedicine facilities exist, they have a significant benefit in managing trauma, enabling prompt diagnosis and interventions in patients referred from metropolitan and rural facilities (15-17). Using this system with the retrieval service can assist by augmenting the delivery of timely, appropriate care, including appropriate patient transfer.

Telemedicine services are vital in remote locations

Pre-transport communication and coordination

The following should occur before a patient is transported:

  • A telephone or videoconference referral, gathering of history, examination, vital signs, and initial investigations.
  • Discussion between referring and receiving senior medical staff, and agreement that transfer is feasible, beneficial and should proceed.
  • Stabilisation advice and institution of any additional management by the referrer.
  • Agreement regarding the required medical and/or nursing attendants during transport.
  • A decision regarding the required monitoring, equipment, and medication.
  • A decision as to the appropriate mode and timing of transportation that considers:
    • The patient’s condition, age, and size.
    • The urgency of transfer.
    • Medical interventions anticipated.
    • Personnel and other resource availability.
    • The time of day.
    • The weather and/or traffic conditions.
    • Geographical considerations.
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