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Victoria’s trauma care system: national implications for quality improvement

Francis T McDermott and Stephen M Cordner
Med J Aust 2008; 189 (10): . || doi: 10.5694/j.1326-5377.2008.tb02174.x
Published online: 17 November 2008

Progressive reduction in trauma mortality and morbidity demands both peer-group and state registry evaluations, with ensuing recommendations implemented by a responsive state government trauma committee

Between 1992 and 2005, the Consultative Committee on Road Traffic Fatalities in Victoria (CCRTF) conducted several studies evaluating trauma care delivery and management in consecutive victims of road traffic accidents who had received medical treatment but subsequently died.1-4 These studies found that, between 1992 and 1997, combined preventable/potentially preventable (P + PP) death rates* among patients who died after road accidents were unaltered (* respectively, survival prospects with optimal treatment assessed as ≥ 75%, and as 25%–74%).1,5 Similarly, the frequency of errors and deficiencies contributing to death was unchanged. In 1997, recommendations were made to reduce identified problems6 and, in response, the Victorian Government established a Ministerial Task Force on Trauma and Emergency Services to implement a statewide integrated trauma system to expedite early definitive care.7


  • 1 Department of Surgery, Alfred Hospital and Monash University, Melbourne, VIC.
  • 2 Department of Surgery, Austin Health and University of Melbourne, Melbourne, VIC.
  • 3 Victorian Institute of Forensic Medicine, Melbourne, VIC.
  • 4 Department of Forensic Medicine, Monash University, Melbourne, VIC.


Correspondence: vicky@vifm.org

  • 1. McDermott FT, Cordner SM, Tremayne AB. Evaluation of the medical management and preventability of death in 137 road traffic fatalities in Victoria, Australia: an overview. Consultative Committee on Road Traffic Fatalities in Victoria. J Trauma 1996; 40: 520-535.
  • 2. McDermott FT, Cordner SM, Tremayne AB. Reproducibility of preventable death judgments and problem identification in 60 consecutive road trauma fatalities in Victoria, Australia. Consultative Committee on Road Traffic Fatalities in Victoria. J Trauma 1997; 43: 831-839.
  • 3. Cooper DJ, McDermott FT, Cordner SM, Tremayne AB. Quality assessment of the management of road traffic fatalities at a level 1 trauma center compared with other hospitals in Victoria, Australia. Consultative Committee on Road Traffic Fatalities in Victoria. J Trauma 1998; 45: 772-779.
  • 4. McDermott FT, Cordner SM, Cooper DJ, Winship VC; Consultative Committee on Road Traffic Fatalities in Victoria. Management deficiencies and death preventability of road traffic fatalities before and after a new trauma care system in Victoria, Australia. J Trauma 2007; 63: 331-338.
  • 5. McDermott FT, Cordner SM, Tremayne AB; Consultative Committee on Road Traffic Fatalities in Victoria. Evaluation of the emergency and clinical management of road traffic fatalities in Victoria 1997. Report of the Consultative Committee on Road Traffic Fatalities in Victoria. Melbourne: Transport Accident Commission, 1998.
  • 6. McDermott FT, Cordner SM, Tremayne AB. Recommendations advised by the learned colleges and specialist societies to counter problems identified by the Consultative Committee in the emergency and clinical management of road traffic fatalities in Victoria. Report of the Consultative Committee on Road Traffic Fatalities in Victoria. Melbourne: Transport Accident Commission, 1997.
  • 7. Victorian Department of Human Services. Review of trauma and emergency services — Victoria. Final report of the Ministerial Task Force on Trauma and Emergency Services and the Department Working Party on Emergency and Trauma Services. Melbourne: DHS, 1999.
  • 8. Victorian Department of Human Services. Victorian State Trauma Registry July 2001–June 2006. Melbourne: DHS, 2008.
  • 9. Boyd CR, Tolson MA, Copes WS. Evaluating trauma care: the TRISS method. Trauma Score and the Injury Severity Score. J Trauma 1987; 27: 370-378.
  • 10. Cameron PA, Gabbe BJ, Cooper DJ, et al. A statewide system of trauma care in Victoria: effect on patient survival. Med J Aust 2008; 189: 546-550.
  • 11. McDermott FT, Cordner SM, Winship VC. Changing practice: the Consultative Committee on Road Traffic Fatalities interactive strategy to improve trauma care. Report of the Consultative Committee on Road Traffic Fatalities in Victoria. Melbourne: Victorian Institute of Forensic Medicine, 2006.
  • 12. Mann NC, Mullins RJ, MacKenzie EJ, et al. Systematic review of published evidence regarding trauma system effectiveness. J Trauma 1999; 47 (3 Suppl): S25-S33.
  • 13. Davis JW, Hoyt DB, McArdle MS, et al. An analysis of errors causing morbidity and mortality in a trauma system: a guide for quality improvement. J Trauma 1992; 32: 660-666.
  • 14. Sampalis JS, Denis R, Lavoie A, et al. Trauma care regionalization: a process-outcome evaluation. J Trauma 1999; 46: 565-581.
  • 15. Gruen RL, Jurkovich GJ, McIntyre LK, et al. Patterns of errors contributing to trauma mortality: lessons learned from 2594 deaths. Ann Surg 2006; 244: 371-380.
  • 16. Nathens AB, Jurkovich GJ, Maier RV, et al. Relationship between trauma center volume and outcomes. JAMA 2001; 285: 1164-1171.

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