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History of the NSW trauma system
From NSW ITIM
The NSW trauma system has come along way since it's first inception.
The first trauma registry in the southern hemisphere was established at Westmead Hospital in January 1985. Trauma registeries were established in other major trauma centres over the coming years.
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 tranported from Lithgow to Sydney in July 1986.
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 (Ref 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 the table below. All other public hospitals in NSW were considered as level 1.
The recommendations of the Policy for Trauma Service also included:
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.
In 1991, the Policy for Trauma Service was revised, with the release of State Trauma Plan document (ref 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 (Ref 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.
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.
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 mojirty 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.
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.
In 1993 the National Road Trauma Advisory Council (NRTAC) released the Report of the Working Party on Trauma Systems (Ref 4). The report made 25 recommendations that included:
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 (Ref 5).
An early trauma notification system was also introduced in 1993 in some rural areas of NSW.
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 registeries 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:
In 1997 the Rural Trauma Plan was released introducing the Early Notification of Severe Trauma - Rural Trauma Triage and Bypass.
The Greater Metropolitan Services Implementation Group (GMSIG) reviewed the NSW trauma system in 2000. The GMSIG report of June 2001 recommendations included:
The recommendations regarding the reduction of adult major trauma services were not implemented for various reason at that time.
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).
The pilot role of the Trauma Clincial 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.
In March 2005, CareFlight in partnership with the Ambulance Service of NSW, launch the Head Injury Retrieval Trial (HIRT)
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.
On the 1st July 2008 the Ambulance Service of NSW Pre-hospital Trauma Triage Protocol (Protocol 4) is replaced by the Protocol T1.
The NSW Collector Trauma Registry, a state wide web based trauma registry, was established in January 2009.
Following a extensive review of the trauma system, NSW Health released the NSW Trauma Services Plan in December 2009. The plan outlines: