Optimal Trauma Care Guidelines

ROYAL AUSTRALASIAN COLLEGE OF SURGEONS MAY 2012 GUIDELINES For a Structured Approach to the Provision of OPTIMAL TRAUMA CARE ROYAL AUSTRALASIAN COLLEGE OF SURGEONS NEW ZEALAND TRAUMA COMMITTEE CONTENTS BRIEF 4 Background 4 Preamble 4 Objective 5 Membership of the Committee 5 RECOMMENDATIONS 6 INTRODUCTION 9 The Trauma System 9 Categories of Trauma Patient 10 Outcome 10 Provision of Optimal Care 10 Guidelines 11 International Precedents 11 GENERAL RESOURCES AND CRITERIA 14 Prehospital Care 14 Triage 14 Physiological Criteria 14 Anatomical Criteria 15 Mechanism of Injury Criteria 16 Transport 16 Hospital Management 17 Resource Guidelines 18 Advanced Trauma Service (ATS) 18 District Trauma Service (DTS) 18 Rural Trauma Service (RTS) 19 Basic Trauma Service (BTS) 19 Recommended Minimum Resource Requirements for Provision of Trauma Care at Different Levels of Trauma Service Provision (Adult) 20 Recommended Minimum Resource Requirements for Provision of Trauma Care at Different Levels of Trauma Service Provision (Child) 24 SPECIALISED REQUIREMENTS 26 Trauma System Coordination 26 Data Collection 26 Remote Geography 26 Retrieval and Transfer Services 27 Emergency Departments 28 Neurosurgery 29 Burns 29 Plastic Surgery 30 Spinal Injuries 30 Cardiothoracic Surgery 30 Paediatrics 31 Services for the Elderly 31 Rehabilitation 31 2 Guidelines for a Structured Approach CONTENTS REFERRAL GUIDELINES 32 Transfer from a Basic Trauma Service a District or Advanced Trauma Service 32 Transfer from a Rural Trauma Service an Advanced Trauma Service 33 Transfer from a District Trauma Service an Advanced Trauma Service 34 REFERENCES 35 APPENDICES 37 1 ‘Quality and Safety Challenge 2012’ Health Quality & Safety Commission of New Zealand and Royal Australasian College of Surgeons 37 2 Trauma Position Statements of the Trauma Committee of the Royal Australasian College of Surgeons 42 3 The Paediatric Trauma Score, The Pediatric Trauma Score as a Predictor of Injury Severity in the Injured Child. J. Pediatric Surg. 22: 14-18, 1987 70 4 Minimum Standards for Transport of Critically Ill Patients. The College of Intensive Care Medicine of Australia and New Zealand, Australian and New Zealand College of Anaesthetists, (IC-10, 2010) and the Australasian College for Emergency Medicine 71 5 Minimum Standards for Intrahospital Transport of Critically Ill Patients. Australian and New Zealand College of Anaesthetists, College of Intensive Care Medicine of Australia and New Zealand, (PS-39, 2010) and the Australasian College for Emergency Medicine 80 6 Guidelines on Inter-hospital Transport of Children, Paediatric Society of New Zealand 85 7 Minimum Standards for Intensive Care Units, College of Intensive Care Medicine of Australia and New Zealand, Australian and New Zealand College of Anaesthetists, (IC- 1, 2010) 93 8 Intensive Care Services for Children in New Zealand, Tertiary Paediatric Review & Literature Summary/Reference List, 1998 107 9 Recommendations on Minimum Facilities for Safe Anaesthesia Practice in Operating Suites. Australian and New Zealand College of Anaesthetists (T1, 2008) 131 10 Statement on Responsibility for Care in Emergency Department: ACEM policy nr-18 139 11 Statement on Emergency Department Role Delineation 143 12 ACEM Policy on Standard Terminology 148 13 Guidelines on Emergency Department Design 153 14 Guidelines for Initial Assessment and Management of Burns Injuries & Pathway to Regional Burn Units 178 15 National Health Emergency Plan: Multiple Complex Burn Action Plan 189 ACKNOWLEDGEMENT This revision of these Guidelines was funded by a grant from the Health Quality and Safety Commission. to the Provision of Optimal Trauma Care 3 BRIEF Background The scale of disease burden due to traumatic injuries can be enormous in the global sense. In New Zealand, injury is the leading cause of death and disability. It is estimated that injury was responsible for more than 1700 deaths and 50,000 hospitalisations per annum.1 Injuries in the home, the workplace, and as a result of sports and leisure activities contribute significantly to the total burden of healthcare. Road traffic crashes are the single leading cause of traumatic death in western motorised countries. In 2011, there were 1.5 million new claims accepted by the Accident Compensation Corporation (ACC)2. During the same period, there were also approximately 1.9 million existing active claims.2 It is estimated that the social and economic costs for the care of the injured are 60 billion dollars per year.1 Although recent road safety measures have been associated with a decrease in total fatality rates there is ample evidence that the number of deaths and serious disabilities could be reduced further by ensuring that the resources for managing trauma accurately match the requirements of the injured patients. The development of a trauma system in New Zealand for the care of trauma patients needs to be focused on ensuring that trauma facilities can provide appropriate resources for injured patients in all situations. Preamble The Guidelines for a “Structured Approach to the Provision of Optimal Trauma Care” were first developed in 1993 by the New Zealand Trauma Committee of the Royal Australasian College of Surgeons (RACS) under the leadeship of its then Chair, Mr Ian Civil, as a project funded by the Ministry of Health. These Guidelines were subsequently revised in 1996 and again in 2003.3 The principle of this document is to ensure that injured patients throughout New Zealand are managed appropriately wherever they receive their care. Over the last decade, this document has served as a resource for matching the level of trauma service care to the severity of injury for New Zealand trauma patients. Funds to revise these Guidelines were made available by the Health Quality and Safety Commission to the RACS and the New Zealand Trauma Committee of the RACS was requested to undertake this project. The Project Implementation Plan is attached (Appendix 1, pp37-41). This revision supports the development of the Major Trauma Clinical Network of New Zealand. These guidelines will be an integral part of a mature trauma system in New Zealand. This document will relate to trauma care at acute care facilities from the time of injury through to the completion of rehabilitation. Appropriate matching of the level of trauma services to patient injures will ensure the best utilisation of resources, prevent inappropriate management and ensure optimal outcome for the patient. These Guidelines aim to provide clear guidance to purchasers of trauma services as to the appropriate components (including intensive care and support services) required to deliver the best patient outcomes. 4 Guidelines for a Structured Approach BRIEF Objective To formulate national guidelines defining the level of trauma care services (including intensive care and support services) required to deliver optimal patient outcomes for specified categories of trauma. Tasks ❑ Assess the current availability of trauma care services (including intensive care and support services). ❑ Revise national guidelines outlined above. This task includes: � definition fo physical trauma � categorisation of types and severity of trauma � specification of the level of trauma care (including intensive care and support services) required for the most optimal management of each identified category of trauma. Membership of the Committee (in 2012) Li Hsee Chairman, Trauma Surgeon, Auckland (Editor-in-Chief) Shanthi Ameratunga Clinical Epidemiologist, Auckland Grant Christey General Surgeon and Trauma Surgeon, Hamilton Grant Coulter General Surgeon, Christchurch Alf Deacon General Surgeon, Nelson Geraint Emrys Corporate Medical Advisor, Accident Compensation Commission Nicholas Finnis Neurosurgeon, Christchurch James Hamill Paediatric Surgeon, Auckland Michael Hogan General Practitioner, Dargaville Amanda Holgate Emergency Physician, Christchurch Dave Parsons National Advisor, Road Safety Training, Police National Headquarters Rhondda Paice Trauma Coordinator, Auckland Mark Sanders General Surgeon, Whangarei Tony Smith Clinical Director, St John Celia Stanyon Executive Officer, Royal Australasian College of Surgeons Mark Stockdale Senior Policy Analyst, Automobile Association Andrew Vincent Orthopaedic Surgeon, Christchurch Richard Wong She Plastic and Reconstructive Surgeon, Auckland to the Provision of Optimal Trauma Care 5 RECOMMENDATIONS It is recommended that... Prehospital Care 1. Page 12 while most pre-hospital care is delivered by ambulance officers, the participation of general practitioners in some geographical areas is necessary and desirable. Triage 2. Page 12-14 where the patient is regarded as having potentially major trauma with immediate threat to life, they should be taken directly to a facility identified as having the capability to stabilise or definitively manage severe trauma. CHILDREN: Paediatric triage criteria are used for children but the same principles apply. Transport 3. Page 14 as standard practice, emergency ambulances should be staffed by two crew members. Ongoing training and financial support should be aimed at ensuring that where case volume is adequate at least one of the crew members is a Paramedic or Advanced Paramedic. CHILDREN: Wherever possible, children are transferred by a specific paediatric transfer service. Hospital Management 4. Page 15 procedures are developed for the coordination of the various surgical and non-surgical specialists, not only in the initial assessment and early definitive care phases, but

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