Transport Time
Where a MTS is within 60 minute transport time from the incident scene, the patient with pMT should be taken to that service, bypassing all other hospitals in order to minimise the time from injury to definitive care. This will also avoid the need for subsequent inter-hospital transfer. This also applies to patients over the age of 65, who have suffered a fall (<1m) causing a head injury with an isolated reduction in their GCS. This patient cohort should be transported directly to a MNS/MTS within 60 minutes, and all other hospitals should be bypassed.
Road transfer
Transport time by road will vary according to many factors including the time of day, traffic conditions and distance. Time will be calculated from loading the patient to the time of arrival at the receiving centre. Some flexibility in the 60-minute timeframe should be shown where a small increment added to transport time means that the patient is delivered to the appropriate facility for definitive care.Where a patient is more than 60 minutes from an MTS, then the patient will be transported by road to the highest level of trauma care available within the 60-minute transport timeframe. In a situation in which a patient appears to be in immediate life-threat during transport, the patient is to be diverted to the nearest designated trauma service for stabilisation, with subsequent transport to a MTS at the earliest appropriate time.
Helicopter transfer
Image used with permission from Departemnt of Health, Victoria
If the flight time is more than 45 minutes and the adult patient has signs of persisting hypovolaemic shock despite resuscitation, a blood transfusion can be commenced pre-hospital. Consultation with the ARV coordinator for destination planning will occur (this may include diversion to a regional trauma service (RTS)). If the patient does not have signs of persisting hypovolaemic shock, they will be transported directly to an MTS.
Persisting hypovolaemic shock
Image used with permission from Ambulance Victoria
Road transfer: Where a major trauma patient appears to be in an immediately life-threatening situation during transport, the patient is to be diverted to the nearest designated trauma service for stabilisation, with subsequent transport to a MTS at the earliest appropriate time.
Helicopter transfer: MICA flight paramedics (MFPs) will assess the patient and initiate resuscitative procedures, administer drugs and perform interventions in accordance with Ambulance Victoria’s Clinical practice guidelines.
If signs of shock are present, then non-hypovolaemic causes need to be excluded, including neurogenic shock in spinal injuries as well as obstructive shock from possible tension pneumothorax and/or cardiac tamponade.
If the trauma patient has signs of hypotensive end-organ impact such as altered conscious state (or intubated), marked pallor, clammy skin or has no response to initial crystalloid resuscitation (20–30 mL/kg), urgent management of that hypovolaemic shock is required.
In such patients, diversion to an RTS may be necessary where capability exists and where flight and landing logistics allow in order to access immediate haemostatic interventions. For this to be considered, an RTS must have available surgical, operating theatre and blood bank capability and capacity. This will be determined and confirmed by the ARV coordinator after consultation with the MFP crew and RTS staff.
The patient will be transferred by road or helicopter (if a helipad is available at the RTS), whichever is quickest.
ARV will also contact a nominated MTS to initiate early referral and case support between RTS clinicians and the MTS clinicians. The patient may be subsequently transferred for definitive care.