History of the NSW trauma system
The NSW trauma system has come along way since it's first inception.
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.
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.
|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|
|Notes:||Mona Vale Hospital|
|*Provisional accreditation given for 2yrs.||Mt Druitt Hospital|
|**Upgrade of Liverpool Hospital to Level 3 a high priority.||Nepean Hospital|
- 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.
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.
|Central Sydney||Royal Prince Alfred|
|Eastern Sydney||Prince of Wales / St Vincent's|
|Northern Sydney||Royal North Shore|
|Southern Sydney||St George|
|South Western Sydney||Liverpool|
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.
|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|
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.
|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|
- 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.
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:
|Old terminolgy||New terminolgy|
| Metropolitan: || Metropolitan: |
| Rural: || Rural: |
| Rural Remote: |
- 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.
In March 2005, CareFlight, in partnership with the Ambulance Service of NSW, launch the Head Injury Retrieval Trial (HIRT).
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
|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|
|Wagga Wagga Hospital|
| *Reinstated as an Adult Major Trauma Service |
for a provisional period after the release of the
NSW Trauma Services Plan
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).
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.
- NSW Health Department, Emergency Services in NSW - Policy for Trauma Service. State Health Publication, NSW Health Department 1988; ISBN 0 7305 33174.
- Steward RI, Bennett C, Gallagher S. Donnelly P. State Trauma Plan. NSW Health Department 1991; ISBN 07305 3531 2.
- NSW Health Department. Blueprint for Health, NSW Health Department 1988.
- 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.
- Progress in Rural Health. Rural Health Directorate, November 1993; State Health Publications - RH 93-138.