Major trauma service

A major trauma service (MTS) is capable of providing the full spectrum of care for the most critically injured patients, from initial resuscitation through to rehabilitation and discharge.¹ These hospitals provide a full range of specialist services (delineated as level 6).² An MTS is equivalent to a Level 1 Trauma Service as documented in the The Australasian Trauma Verification Program Manual by the Royal Australasian College of Surgeons¹ and as seen in the international literature.

MTS locations

There are currently 7 adult and 3 paediatric designated MTS in NSW:

Adult MTS:

John Hunter Hospital
Liverpool Hospital
Royal North Shore Hospital
Royal Prince Alfred Hospital
St George Hospital
St Vincent's Hospital
Westmead Hospital

Paediatric MTS:

John Hunter Children's Hospital
Sydney Children's Hospital
The Children's Hospital at Westmead

Canberra Hospital is also formally recognised as a MTS within the NSW trauma networks as it provides a trauma tertiary referral role to the Southern NSW Local Health District.³

Role of the MTS

As per the The Australasian Trauma Verification Program Manual,¹ an MTS will be capable of providing the full spectrum of care for the most critically injured patient, from initial reception and resuscitation through to discharge and rehabilitation. As well as this the MTS provides:

Research
Education & Fellowship training
Trauma Systems overview
Quality improvement program
Data collection
Prevention and outreach programs
Trauma audit
Leadership responsibilities

An MTS will have significant case volumes to sustain clinical excellence. There will be a 24 hour trauma reception team, prompt 24 hour availability of senior consultant level general surgeon, an appointed trauma director and, ideally, a surgical trauma admitting service (bed card). Elective and Emergency surgery in neurosurgery, cardiothoracic, orthopaedics and plastics are essential for an Adult MTS .

An MTS will essentially have first class facilities including emergency department, operating theatre suite, and intensive care units, with dedicated emergency O.R. availability 24 hours for Trauma.

An MTS should be the ‘central hub’ of an integrated system, with responsibility for coordination of other services both urban and rural in any given region, and for advising such Trauma Services. Transfer agreements for reception of patients from those other Trauma Services should be in place. A helipad landing site is essential as well as road and ambulance reception.

An MTS will take a lead role in the coordination and management of mass casualty and disaster preparedness scenarios.

A MTS acts as the principal hospital for reception of inter hospital transfer of major trauma patients.

MTS staffing infrastructure

The day-to-day coordination of multidisciplinary activities, services and systems necessary to provide to the highest level of trauma care within the MTS are led by the Trauma Director and the Trauma Nurse Coordinator. A recommended minimal level of staffing infrastructure of the MTS can be seen below (adapted from NSW Trauma Services Plan - Dec 2009).

Role	Adult MTS	Paediatric MTS
Trauma Director	Full time	Part time
Trauma Fellow	Full time	Part time
Trauma Nurse Coordinator (CNC)	Full time	Part time
Area Trauma Nurse Coordinator (CNC)	Full time	Part time
Trauma Registry Manager	Full time	Part time
Trauma Case Manager (CNS)	Full time	Part time

References

Royal Australasian College of Surgeons (2009). The Australasian Trauma Verification Program Manual. Melbourne: RACS.
NSW Health (2002). Guide to the Role Delineation of Health Services. Sydney: NSW Health.
NSW Department of Health (2009). Selected Specialty and Statewide Service Plans: NSW Trauma Services. Sydney: NSW Department of Health. pp. 37.