Key Messages

Pre-hospital triage aims to minimise morbidity and mortality by ensuring all patients receive appropriate care in a safe and timely manner. Effective pre-hospital triage in major trauma is based upon patient factors, mechanism, pattern of injury, resource availability and geographic location.(1, 2) As patient outcomes are strongly associated with timely transport to an appropriate healthcare facility, (3) the Victorian State Trauma System (VSTS) aims to ensure all major trauma patients receive the majority of their care in a major trauma service (MTS) or suitable alternative (i.e.: Victorian Spinal Cord Service at the Austin, Metropolitan Neurological Services for older head injured patients). Non-major trauma patients should remain in an appropriate local service.

Since 2016–17 direct admissions from the scene of injury, home or a GP to an MTS were consistently more prevalent than referrals from another health service. The number and proportion of major trauma patients transported directly from the scene of injury, home or a GP to The Alfred, The Royal Melbourne Hospital and The Royal Children’s hospital have slowly increased over the past five years. Between 2016-2017 and 2020-2021 the percentage has increased from 65.8% to 66.1%, demonstrating a slow and steady consistent trend. More importantly, 90% of transferred patients received their care at an appropriate trauma service as defined by the major trauma guidelines in 2020-21. (4)

In the out of hospital setting in Victoria, three points are used to assist in the identification of major trauma. When any one of the three criteria points are met, the patient is defined as a major trauma patient. The patient is either ‘actual time critical’ when there is abnormal vital signs, ‘emergent time critical’ when there is an assumed or actual injury or ‘potential time critical’ when an at-risk patient has sustained a high risk mechanism that is often associated with significant traumatic injury. These points are further explained throughout the guideline.
These guidelines have been developed under the auspices of the Trauma System Advisory Committee (TSAC) using ‘AGREE II’ methodology, and are designed to enhance the early care of major trauma patients.

   Injury can happen anywhere, anytime
     Image used with permission from Ambulance Victoria



Clinical emphasis points

  • Victoria’s trauma system guidelines are designed to ensure every patient is always cared for in the most appropriate facility.
  • Expert scene assessment and initial out of hospital management of life-threatening injuries is essential.
  • Defined triage guidelines allow the identification of patients fulfilling major trauma criteria.
  • Initial dispatch to the scene via either road or air must be well coordinated, and early input from Air Ambulance Victoria (AAV) and retrieval services; Adult Retrieval Victoria (ARV) and Paediatric Infant Perinatal Emergency Retrieval (PIPER) is recommended for cases that cannot reach the major trauma services within 60min by road.
  • Early planning of transport to the major trauma care destination is essential.
  • Currently in Victoria, there are two adult & one paediatric facilities that are designated major trauma service (MTS) hospitals.