On occasions paramedics may play an active role in the trauma team within rural or regional facilities where availability of experienced and skilled hospital staff may be limited. Clinicians should, therefore be sourced from throughout the hospital.” Trauma team members should comprise the most skilled clinicians available to fulfil each roll within the team. Clarifying the roles and responsibilities of each member of the team enables an optimally coordinated approach during resuscitation, when many tasks must be carried out simultaneously. The establishment of a trauma team is crucial to this. All hospitals designated to receive trauma patients must have a formal organised response to the initial reception and management of trauma patients. “The multidisciplinary trauma team approach to trauma resuscitation and stabilisation is one recommended by several bodies (ACS, 1993 NRTAC, 1993). Image used with permission from Department of Health, VictoriaThe Review of Trauma and Emergency Services (RoTES) report (1999 4) underpins much of the Victorian State Trauma System and specified the following in response to the general team approach to early management of major trauma patients: Transport accidents are one of the most common causes of injury ARV provides clinical advice on the management and stabilisation of major trauma patients and coordinates subsequent retrieval and transfer if required. Patients who meet major trauma criteria outlined in the Major Trauma Advice and Inter-hospital Transfer Guidelines should be stabilised at the referral health service and discussed with ARV within 60 minutes of arrival to arrange for transfer to a major trauma service. 2 This means that around one in threemajor trauma patients will be managed initially at a peripheral hospital or health service. Overall, the percentage of major trauma patients receiving definitive care at an MTS, the Austin for spinal, or an MNS transported directly from the scene of injury, home or GP has decreased from 70% in 2011-2012 to 65% in 2015-2016. 3 The annual incidence rate of paediatric major trauma patients (aged younger than 16 years) remains low, at 13 per 100.000 in 2015-2016. The incidence of falls less than 1m is rising in this age group, with head injuries being the most common serious injury sustained in this demographic. This represents approximately one-third of all major trauma cases. In recent years there has been an increase in the number of major trauma patients aged over 65 years. Falls, motor vehicle accidents, motorbike accidents, pedestrian impacts and incidents involving pedal cyclists are the most common mechanisms of injury. Therefore, these are the areas targeted by the primary survey. The leading causes of death in trauma patients are airway obstruction, respiratory failure, hemorrhagic shock, and brain injury. The majority of trauma in Victoria is predominantly blunt trauma. The primary survey is designed to assess and treat life-threatening injuries rapidly. Of these, 40% of patients meet major trauma criteria requiring an intensive care admission, and three-quarters of these patients are mechanically ventilated. Victorian hospitals treat more than 3,000 major trauma patients each year, and this number is increasing by 5% per annum, with 80% being managed at an appropriately designated trauma service.
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