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- Victorian State Trauma System

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  • 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

              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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