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.
- John Hunter Hospital
- Liverpool Hospital
- Royal North Shore Hospital
- Royal Prince Alfred Hospital
- St George Hospital
- St Vincent's Hospital
- Westmead Hospital
- John Hunter Children's Hospital
- Sydney Children's Hospital
- The Children's Hospital at Westmead
Role of the MTS
- 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.
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|
- 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.