History of the NSW trauma system

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  • 2021

    In December 2021, the NSW trauma verification program started, as part of the implementation of the Trauma services model of care. It involves multidisciplinary teams from the Royal Australasian College of Surgeons verifying 20 NSW trauma services over three years.

    In January 2021, the statewide Trauma Death Review program started. A key recommendation from the 2016 evaluation of the trauma system, it will link numerous data sources in order to gain a comprehensive picture of the circumstances surrounding the deaths of trauma patients and identify any statewide issues. The program is a major initiative of the ITIM clinical review committee.

  • 2019

    In 2019, NSW ITIM published the NSW Trauma services model of care. This was a key recommendation from the 2016 evaluation of the trauma system.

    The objectives of the model of care are:

    • clarity and transparency across system around trauma service function and structure
    • stronger trauma network referral arrangements and support for regional trauma services
    • reducing unwarranted clinical variation with trauma care delivery and patient outcomes to ensure consistent quality of care is delivered to trauma patients regardless of where they are injured in NSW
    • developing a more patient-focused trauma system in NSW
    • improving coordination across various clinical networks at ACI and local health districts involved in the ongoing care and rehabilitation of trauma patients.
  • 2018

    In 2018, NSW ITIM started the Trauma outcomes registry and quality improvement (TORQUE) project.

    TORQUE consists of two components. These recommendations came from the 2016 evaluation of the trauma system:

    • The redesign and development of the NSW Trauma Registry
    • The introduction of patient-reported measures.
  • 2016

    In 2016, NSW ITIM completed an evaluation of the NSW trauma system. This was the Trauma patient outcomes evaluation (TPOE).

    TPOE's purpose was to review:

    • resources and resourcing components of NSW trauma services
    • paediatric outcomes by agency retrieval providers

    The resulting quantatative and qualitative reports formed the basis for the major strategic directiion and projects for ITIM over the following years.

  • 2012

    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 portfolio.

  • 2010

    In January 2010, the NSW Trauma Minimum Dataset, 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).

  • 2009

    The NSW Collector Trauma Registry, a statewide 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 outlined:

    • designation of trauma services in NSW; 7 adult and 3 paediatric major trauma services, with 10 regional trauma services
    • trauma model of care
    • projected demands on the trauma services
    • monitoring the trauma system

  • 2008

    On the 1st July 2008 the Ambulance Service of NSW Pre-hospital Trauma Triage Protocol (Protocol 4) is replaced by the Protocol T1.

  • 2007

    IIn May 2007, Canadian Helicopter Corporation won a tender process so Westpac Lifesaver Rescue Helicopter Service and CareFlight ceased to supply helicopter services in the Sydney region to the Ambulance Service of NSW. CareFlight continues to supply medical staff to NSW medical retrieval system. Westpac Lifesaver Rescue Helicopter Service continues to supply helicopter services in regional NSW.

  • 2005

    In March 2005, CareFlight, in partnership with the Ambulance Service of NSW, launched theHead Injury Retrieval Trial (HIRT).

  • 2004

    The role of the trauma clinical support officer began in January 2004 for a six-month trial. NSW ITIM funded two positions with the Ambulance Service of NSW until June 2008. These became obsolete by the establishment of the Ambulance Service of NSW Major Trauma Program.

  • 2002

    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)

  • 2000

    The Greater Metropolitan Services Implementation Group (GMSIG) reviewed the NSW trauma system in 2000.

    The GMSIG report of June 2001 recommendations included:

    • a 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
    • John Hunter Children's Hospital would be recognised as a paediatric trauma service
    • the establishment of a virtual NSW Trauma Institute.

    The recommendations regarding the reduction of adult major trauma services were not implemented for various reason at that time.

  • 1997

    In 1997 the Rural Trauma Plan was released, introducing the Early Notification of Severe Trauma - Rural Trauma Triage and Bypass (Protocol 4-Rural) for use by the Ambulance Service of NSW.

  • 1994

    In 1994 NSW Health reviewed the trauma system to bring it into line with the National road trauma advisory council recommendations. As a result of the review, the NSW trauma systems advisory committee, 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
    • 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 funds to establish and maintain local trauma registries (a computerised database).

  • 1993

    In 1993 the National road trauma advisory council released the Report of the Working Party on Trauma Systems.

    The report made 25 recommendations that included:

    • 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.

    NSW Health also updated the State Trauma Plan to take into account the the restructuring of rural areas into health districts.9

    An early trauma notification system was also introduced in 1993 in some rural areas of NSW.

  • 1992

    On 29th March 1992, the pre-hospital component of the State Trauma Plan was activated in Sydney through the introduction of the NSW Ambulance Pre-hospital Trauma Triage Protocol (Protocol 4). The aim was to minimise inter-hospital transfers, enabling more patients to be transported 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.

  • 1991

    In 1991, the Policy for Trauma Service was revised, with the release of the State Trauma Plan, 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.

    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.

  • 1988

    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. They released the document Policy for Trauma Service, which outlined a three-tier system of acute hospitals providing care for the injured, with level 3 hospitals providing the highest level of care.

    The recommendations of the Policy for Trauma Service also included:

    • 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.

    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.

  • 1986

    The first trauma team activation in Australasia occured at Westmead Hospital on 1st July 1986.

    CareFlight's first helicopter patients, two paediatrics involved in a motor vehicle crash, were transported from Lithgow to Sydney in July 1986.

  • 1985

    The first trauma registry in the southern hemisphere was established at Westmead Hospital in January 1985. Trauma registries were established in other major trauma centres over the coming years.

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