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.