Improving pre-hospital major trauma clinical performance

Major trauma patients who require secondary retrieval from local hospitals, are at risk of being potentially undertriaged, and are not consistently identified for clinical review. Secondary retrieval takes place when a patient is required to be moved to a secondary location for upgraded clinical care, usually a specialist trauma service hospital.

This project aims to identify reasons for the secondary retrieval and address areas where improvements to paramedic management may be made.


To decrease the total number of pre-hospital undertriaged major trauma patients by 50% in Western Zone 1 within a 12 month period.


  • Patients: timely access to definitive care and a restriction in exacerbation of injury and/or injuries.
  • Health system: the potential for a decreased length of stay and decreased costs.
  • Staff: being empowered to provide patients with an opportunity for improved outcomes.


If a patient requires upgraded clinical trauma care, a secondary retrieval transport is undertaken to a trauma service hospital. When secondary retrieval transports occur, the primary pre-hospital management of the patient may not routinely be identified for clinical review.

Evidence that showed this includes the Information Incident Management System (IIMS), linked data analysis (CATE registry), and the NSW Ambulance Retrieval Clinical Manager.

Current key performance indicators rely on the patient being documented as 'T1', ‘major trauma’ and ‘non-compliant’ to instigate a case review.

This project will research and identify reasons for the secondary retrieval and then address areas where improvements to paramedic management may be made.

The project team will review appropriate secondary transport cases for a 12 month period to identify any gaps in clinical decision making and then determine the causes for these gaps which will become the primary drivers for improvement.

Areas to be monitored will include patient age group, mechanism of injury, clinician documentation which includes undertriaged cases.

Following determination of the primary drivers, secondary drivers and change ideas will then be developed and subsequently categorised and prioritised for Plan, Do, Stop, Act testing in order to work towards meeting the project’s aim.



Implementation – The initiative is ready for implementation, is currently being implemented, piloted or tested.

Further reading


Colin Deans
Trauma Clinical Manager
NSW Ambulance
Phone:  02 9779 3806


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