History of the NSW trauma system

The NSW trauma system has come along way since it's first inception.

1985

The first trauma registry in the southern hemisphere was established at Westmead Hospital in January 1985. Trauma registries were established in other major trauma centres over the coming years.

1986

The first trauma team activation in Australasia was at Westmead Hospital on 1st July 1986.

CareFlight's first helicopter patients (2 paediatrics involved in a motor vehicle crash) are transported from Lithgow to Sydney in July 1986.

1988

In November 1988, on the basis of strong professional support and international evidence, the NSW Health Department endorsed the establishment of a network of regional trauma services that would improve trauma outcomes, releasing the document Policy for Trauma Service.1 The proposal incorporated a three tier system of acute hospitals providing care for the injured, with level 3 hospitals able to provide the highest level of care. Proposed level 3 and 2 hospitals are listed in table 1 below. All other public hospitals in NSW were considered as level 1.

Trauma roles of NSW Hospitals
Level 3 Level 2 (urban) Level 2 (rural)
Royal Newcastle Hospital Auburn Hospital Albury Hospital
Royal North Shore Hospital Bankstown Hospital Broken Hill Hospital
Westmead Hospital Blacktown Hospital Dubbo Hospital
  Campbelltown Hospital Goulburn Hospital
Provisional:* Canterbury Hospital Lismore Hospital
Prince of Wales/Prince Henry Hospital Concord Hospital Orange Hospital
Royal Prince Alfred Hospital Gosford Hospital Tamworth Hospital
St George Hospital Hornsby Hospital Wagga Wagga Hospital
St Vincent's Hospital Liverpool Hospital** Wollongong Hospital
  Manly Hospital  
Notes: Mona Vale Hospital  
*Provisional accreditation given for 2yrs. Mt Druitt Hospital  
**Upgrade of Liverpool Hospital to Level 3 a high priority. Nepean Hospital  
  Ryde Hospital  
  Sutherland Hospital  
The recommendations of the Policy for Trauma Service also included:
  • An administrative structure at hospital level with designated clinical leaders, trauma service directors supported by trauma committees, and clinical review based on data collection.
  • Trauma education be provided to the public and training in trauma management be provided to health providers.
  • A plan of regionalisation with each highest level centre linked to a geographic area of responsibility within NSW.
The first Early Management of Severe Trauma (EMST) participant course in Australasia was conducted in Melbourne in Decemeber 1988 with a combined Australasian and American faculty. The first EMST instructor course in Australasia was held in Sydney in Dec 1988. The first EMST participant course, with an all Australian faculty, was held in Orange in March 1989.

1991

In 1991, the Policy for Trauma Service was revised, with the release of the State Trauma Plan document,2 marking the formal establishment of a trauma system in NSW. The plan reflected the structural changes in NSW Health including the the reorganisation of the health system into ten health areas and six rural regions.3

Supra-Area trauma services had the responsibility for overseeing and coordinating education, quality assurance and data collection activities relating to trauma. They also had a role in offering guidance and in accepting interhospital transfers where the resources of the treating hospital, be it a local, Regional or Area trauma service, are outstripped by the complexity of the patient's condition.

NSW Trauma Services
AreaHospital
Central Coast Gosford
Central Sydney Royal Prince Alfred
Eastern Sydney Prince of Wales / St Vincent's
Hunter John Hunter
Illawarra Wollongong
Northern Sydney Royal North Shore
Southern Sydney St George
South Western Sydney Liverpool
Wentworth Nepean
Western Sydney Westmead

Area Trauma Services for Children functioned as temporary resuscitation stops for seriously injured children. Children for whom definitive treatment could not be provided were transferred to one of the State Trauma Services for Children.

Paediatric Trauma Services
State Trauma Service Area Trauma Service
Royal Alexandra Hospital for Children Hornsby Hospital
Prince of Wales Children's Hospital St George Hospital
John Hunter Hospital Nepean Hospital
Westmead Hospital

Only until transfer of RAHC to the Westmead site

Royal North Shore Hospital
Liverpool Hospital

The function of the Rural Regional trauma services was to coordinate the delivery of trauma services in the Region or Regional Sector in which it is located. Retrieval services should, where practicable, be run from these centres. Definitive care was offered to a majority of patients at the trauma centre following stabilisation and transfer from other locations. Transfers of highly complex cases to the metropolitan hospitals continued as required.

Regional Trauma Services
RegionHospital
New England Tamworth
North Coast Lismore base
Central Western Orange Base
Orana & Far West Dubbo Base / Broken Hill Base
South Eastern Goulburn base
South West Wagga Wagga Base / Albury Base

1992

On 29th March 1992 the pre-hospital component of the State Trauma Plan was activated in Sydney through the introduction of NSW Ambulance Pre-hospital Trauma Triage Protocol (Protocol 4). The aim was to minimise inter hospital transfers and to enable more patients to be delivered by ambulance to the hospital most appropriate for their eventual needs. The introduction of Protocol 4 resulted in patients with serious injury being transported directly to a major trauma service hospital, even if it meant bypassing a local hospital.

1993

In 1993 the National Road Trauma Advisory Council (NRTAC) released the Report of the Working Party on Trauma Systems.4 The report made 25 recommendations that included:
  • Regional trauma systems based on networks and linkages
  • Designation of hospitals resourced to provide a level of care
  • Establishment of State and Territory Trauma Systems Management Committees to implement the NRTAC report and to monitor the established trauma systems

The NSW Health Department also updated the State Trauma Plan in 1993 to take into account the the restructuring of rural areas into Health Districts.5

An early trauma notification system was also introduced in 1993 in some rural areas of NSW.

1994

In 1994 the NSW Health Department reviewed the trauma system to bring it into line with the NRTAC recommendations. As a result of the review, the NSW Trauma Systems Advisory Committee (TSAC), a subcommittee of the NSW Critical Care Advisory Committee, was established. The role of TSAC was to coordinate the system wide organisation of trauma services, review the performance of core components and provide feedback to NSW Health and NSW Trauma Networks and review trauma related services such as retrieval.

TSAC established the NSW Trauma Monitoring Program, analysing data from the Ambulance Service of NSW, trauma service registries and the Police Report of Death Registry. The NSW major trauma services were provided with seeding funds to establish and maintain local trauma registries (a computerised database).

The terminology describing trauma services in NSW was also updated as per the NRTAC recommendations. Trauma services were now described using the following terminology:

Change in terminology
Old terminolgy New terminolgy
Metropolitan:
  • Area Trauma Hospital
  • Local Trauma Hospital
Metropolitan:
  • Major Trauma Service
  • Urban Trauma Service
Rural:
  • Base Hospital
  • District Hospital
Rural:
  • Regional Trauma Service
  • Rural Trauma Service
  Rural Remote:
  • Remote Trauma Service

1997

In 1997 the Rural Trauma Plan was released introducing the Early Notification of Severe Trauma - Rural Trauma Triage and Bypass.

2000

The Greater Metropolitan Services Implementation Group (GMSIG) reviewed the NSW trauma system in 2000. The GMSIG report of June 2001 recommendations included:
  • Reduction of the number of major trauma services in greater Sydney metropolitan area from eight to five;
  • Specialist paediatric trauma services would remain at the Sydney Children's Hospital and The Children's Hospital at Westmead; and
  • John Hunter Children's Hospital to be recognised as a paediatric trauma service.
  • The establishment of a virtual NSW Trauma Institute.
The recommendations regarding the reduction of adult major trauma services were not implemented for various reason at that time.

2002

The Provisional NSW Trauma Institute was established in late January 2002 as a result of recommendations of the GMSIG report of June 2001. On 16th May 2002 the Minister for Health, the Hon. Craig Knowles MP, announced the establishment of the newly named NSW Institute of Trauma and Injury Management (ITIM).

2004

The pilot role of the Trauma Clinical Support Officer commenced in January 2004 for a six month trial. NSW ITIM funded the Ambulance Service of NSW for two positions until June 2008, when the position was made obsolete by the establishment of the Ambulance Service of NSW Major Trauma Program.

2005

In March 2005, CareFlight, in partnership with the Ambulance Service of NSW, launch the Head Injury Retrieval Trial (HIRT).

2007

In May 2007, the Westpac Lifesaver Rescue Helicopter Service and CareFlight contracts to supply helicopter services in the Sydney region to the Ambulance Service of NSW ended when the Canadian Helicopter Corporation won a tender process. CareFlight continues to supply medical staff to NSW medical retrieval system. Westpac Lifesaver Rescue Helicopter Service continues to supply helicopter services in regional NSW.

2008

On the 1st July 2008 the Ambulance Service of NSW Pre-hospital Trauma Triage Protocol (Protocol 4) is replaced by the Protocol T1.

2009

The NSW Collector Trauma Registry, a state wide web based trauma registry, was established in January 2009.

Following an extensive review of the trauma system, NSW Health released the NSW Trauma Services Plan in December 2009. The plan outlines:

  • Designation of trauma services in NSW: 7 adult and 3 paediatric major trauma services with 10 regional trauma services (see table below)
  • Trauma model of care
  • Projected demands on the trauma services
  • Monitoring the trauma system
Trauma designation of NSW Hospitals
Adult Major Trauma Services Paediatric Major Trauma Services Regional Trauma Services
John Hunter Hospital John Hunter Children's Hospital Coffs Harbour Base Hospital
Liverpool Hospital Sydney Children's Hospital Gosford Hospital
Royal North Shore Hospital The Children's Hospital at Westmead Lismore Base Hospital
Royal Prince Alfred Hospital   Nepean Hospital
St George Hospital   Orange Health Service
St Vincent's Hospital*   Port Macquarie Base Hospital
Westmead Hospital   Tamworth Hospital
   Tweed Hospital
   Wagga Wagga Hospital
   Wollongong Hospital
Notes:  
*Reinstated as an Adult Major Trauma Service
for a provisional period after the release of the
NSW Trauma Services Plan
  

2010

In January 2010, the NSW Trauma Minimum Data Set, as collected by the NSW Trauma Services, is expanded to include injuries with an Injury Severity Score (ISS) greater than 12 (moderate injuries). It was previously ISS greater than 15 (severe injuries).

2012

In November 2012, NSW ITIM transitioned to become part of the Agency for Clinical Innovation, reporting to the Director of the Surgical, Anaesthesia and Critical Care (SACC) portfolio.

References

  1. NSW Health Department, Emergency Services in NSW - Policy for Trauma Service. State Health Publication, NSW Health Department 1988; ISBN 0 7305 33174.
  2. Steward RI, Bennett C, Gallagher S. Donnelly P. State Trauma Plan. NSW Health Department 1991; ISBN 07305 3531 2.
  3. NSW Health Department. Blueprint for Health, NSW Health Department 1988.
  4. National Road Trauma Advisory Council, Report of the Working Party on Trauma Systems - Commonwealth Department of Health, Housing, Local Government arid Community Services. Canberra 1993 ISBN 064429691 7.
  5. Progress in Rural Health. Rural Health Directorate, November 1993; State Health Publications - RH 93-138.

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