Paediatric
Anaesthetics
| Level 1 |
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No level 1 service. Please refer to a higher level.
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| Level 2 |
- Non-general anaesthesia by a non specialist anaesthetist (includes intravenous sedation and analgesia)
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| Level 3 |
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As for Level 2 plus:
- General anaesthesia given by a non-specialist anaesthetist for low risk surgery (e.g. grommets, dental), on low risk children (as per Australian Society of Anesthetists)
or (e.g. ASA 1 or 2) 4 years and over and ≥ 20 kilograms in weight
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| Level 4; |
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As for Level 3 plus:
- General anaesthesia given by a non- specialist and visiting specialist anaesthetist for:
- low risk children (e.g. ASA 1-3)
under the age of 4 years and
≥20 kilograms in weight and
- simple or moderate complexity surgery (e.g. tonsillectomy, adenoidectomy, appendectomy)
- Specific anaesthetic staff support available
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| Level 5 |
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As for Level 4 plus:
- General anaesthesia for children of all ages given by specialist
paediatric skilled anaesthetist
- Anaesthetic registrar on-site or on-call 24/7
- Consultant anaesthetist on-call or on roster 24/7
- For moderate risk/complexity children (e.g ASA 1-3)
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| Level 6 |
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As for Level 5 plus:
- Sub-specialist services
- Statewide referral, advisory, consult, teaching and research role
- Broad range of anaesthetic services
- High risk children, all ages complex procedures
- Post anaesthesia care available in a paediatric and/or neonatal ICU
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Emergency
| Level 1 |
- Care by RN with oversight by GPs (potentially visiting)
- Stabilisation and first aid
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| Level 2 |
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As for Level 1 plus:
- Resuscitation and stabilisation
- Care provided by general practitioner
- On-call paediatric advice from higher level centres
- Established pathway for child protection or family/paediatric skilled social worker
- Participates in care of minor trauma
- Possible resuscitation of a major trauma patient, with rapid transfer on
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| Level 3 |
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As for Level 2 plus:
- Local GPs roster to provide 24/7 cover with service by RN
- Resuscitation and stabilisation
- Access to visiting specialist services or by Telehealth
- Access to dental service for dento- alveolar trauma and infection
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| Level 4; |
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As for Level 3 plus:
- Emergency physicians
- Emergency operating theatre facilities
- Access to on- site and on-call paediatrician
- Access to paediatric skilled SRN/CNS
- Access to paediatric skilled allied health
- On-site child protection or paediatric skilled social worker
- Access to dental advice/consult for paediatric mouth and facial bone trauma
- Participation in under and post graduate training all professions
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| Level 5 |
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As for Level 4 plus:
- Designated paediatric emergency area including paediatric short stay unit/area
- Paediatric emergency medicine team
- Paediatric consultant on-call 24/7
- Paediatric skilled nursing
- Access to on-site paediatric medical and paediatric surgical services
- Access to specialised allied health skilled in paediatric care
- Access to paediatric suitable diagnostic services
- Accepts transfers from other hospitals in region
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| Level 6 |
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As for Level 5 plus:
- Paediatric emergency medicine consultant on duty 24/7*
- Statewide referral role
- Access to full range of medical and surgical specialists skilled in paediatrics
- Access to full range of diagnostic services
- Access to paediatric ICU
- On-site child protection services
* Not currently operating in WA
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General medical outpatient
| Level 1 |
- Access generalist domiciliary nursing
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| Level 2 |
- GP service with e-health/telephone paediatric advice
- Established pathway for child protection or family/paediatric skilled social worker
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| Level 3 |
- Outpatient care by visiting paediatrician and paediatric skilled GP on-site or in local community
- Access to general outpatient allied health services
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| Level 4; |
- Outpatient consultation by paediatrician
- Outpatient consultation by visiting paediatric specialists
- Consults on- site or in local community
- Integrated paediatric physician and specialty service with paediatric specialties
- Paediatric skilled allied health on- site or in local community
- Access to child protection or paediatric skilled social worker
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| Level 5 |
- Outpatient consultation and care by paediatrician and range of paediatric specialists on- site or in local community
- Integrated paediatric and surgical services
- Access to specialised allied health services
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| Level 6 |
- Complex paediatric outpatient consultations by on-site sub- specialists
- Specialised paediatric skilled allied health and nursing outpatient services
- Targeted patient/ family education, care coordination and/or community transition for at risk/difficult to engage cohorts
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General medical
| Level 1 |
- Care by RNs with oversight by GPs (potentially visiting)
- Stabilisation and first aid
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| Level 2 |
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As for Level 1 plus:
- Access to medical beds suitable for paediatric care
- Care provided by general practitioner
- On-call paediatric advice from higher level centres
- Established pathway for child protection or family/paediatric skilled social work
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| Level 3 |
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As for Level 2 plus:
- May have designated paediatric beds/ ward including short stay managed by paediatric skilled staff
- Access to some allied health services in liaison with higher level paediatric services
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| Level 4; |
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As for Level 3 plus:
- Inpatient care by paediatrician
- Paediatric skilled ENs, RNs and CNs; and access to specialist SRN
- Access to paediatric skilled allied health
- Access to resident/RMO rotations from Level 5 or 6 facility
- Designated paediatric beds/ ward including short stay
- Contributes to undergraduate education
- Patient/family education services integrated with community care
- On-site child protection or paediatric skilled social worker
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| Level 5 |
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As for Level 4 plus:
- Paediatric registrar on-call 24/7 /RMO on-site
- Access to inpatient consultation by paediatric specialists
- Designated paediatric skilled specialised allied health
- Designated paediatric ED with paediatric ESSU
- Designated same day paediatric medical services
- Range of paediatric hospital avoidance, rapid assessment and ambulatory programs
- Undergraduate teaching role in medical, nursing and allied health disciplines
- Support in paediatric care to other sites
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| Level 6 |
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As for Level 5 plus:
- Comprehensive care, including emergency care
- Access to full range of hospital substitution; specialised/ targeted and same day medical services
- Specialised inpatient paediatric skilled allied health services
- Statewide referral, advisory, decision support, consult, teaching and referral role in medical, nursing and allied health disciplines
- Paediatric and neonatal ICU
- On-site or 24/7 access paediatric skilled anaesthetic services
- On-site child protection providing state- wide support to other sites
- Specialist SRN
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General surgery outpatient
| Level 1 |
| No level 1 service. Please refer to a higher level. |
| Level 2 |
- GP service with telephone/ Telehealth paediatric advice
- Access to domiciliary nursing
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| Level 3 |
- Access to general allied health services in liaison with higher level paediatric services
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| Level 4; |
- Outpatient care associated with inpatient sessions
- Outpatient consultation by some specialists skilled in paediatrics or consultant paediatrician on-site or in community
- Access to designated paediatric skilled allied health on-site or in community
- Access to child protection or paediatric skilled social worker
- Integrated surgical and paediatric physician service for some cases
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| Level 5 |
- Outpatient care of surgical events; diagnostic and more complex outpatient care
- Access to paediatric skilled allied health and nursing services
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| Level 6 |
- Complex paediatric outpatient consultation by paediatric surgical specialists
- Specialised paediatric skilled allied health, technical and nursing services
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General surgery
| Level 1 |
- Stabilisation and first aid
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| Level 2 |
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As for Level 1 plus:
- Minor outpatient and same day procedure by GP via local anaesthesia only
- Visiting GP; no post surgical inpatient care
- On-call paediatric advice
- Established pathway for child protection or family/paediatric skilled social worker
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| Level 3 |
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As for Level 2 plus:
- Day surgery, uncomplicated elective and some emergency surgery by GP, general surgeon or visiting paediatric surgeons
- Designated paediatric ward/ beds
- Visiting paediatric skilled anaesthetist
- Inpatient medical/ nursing care by GP and paediatric skilled RNs
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| Level 4; |
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As for Level 3 plus:
- Non-complex mainly elective surgery by visiting paediatric skilled surgeon and some specialty surgeons skilled in paediatric surgery
- Paediatric skilled consultant anaesthetist
- Paediatric skilled RNs and CN
- Access to paediatric skilled SRN/CNS
- Access to designated paediatric skilled allied health
- On-site child protection or paediatric skilled social worker
- Inpatient medical care by paediatrician
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| Level 5 |
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As for Level 4 plus:
- Paediatric skilled surgeons, surgical registrar/RMO
- 24/7 on-call paediatric anaesthetist
- 24/7 surgical registrar
- Inpatient medical care by paediatric team with 24/7 paediatric registrars
- Paediatric skilled SRN/CNS
- Designated paediatric skilled allied health
- Designated paediatric ED with paediatric ESSU
- Designated paediatric surgical support services
- Range of paediatric rapid assessment and acute ambulatory programs
- Inpatient medical care by 24/7 paediatrician team/registrar
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| Level 6 |
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As for Level 5 plus:
- Designated paediatric and neonatal ICU
- On-site or 24/7 paediatric anaesthetic services
- Specialist SRN
- Full range of hospital substitution, specialised/ targeted ambulatory and same day services
- On-site child protection including referral from and support of lower level sites
- Specialised inpatient and outpatient paediatric skilled allied health services
- Statewide referral, advisory, decision support, consult, teaching and referral role - medical, nursing and allied health disciplines
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Operating theatres
| Level 1 |
| No level 1 service. Please refer to a higher level. |
| Level 2 |
- Minor procedure capability no emergency operating theatre
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| Level 3 |
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As for Level 2 plus:
- Single operating theatre for minor/same day procedures
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| Level 4 |
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As for Level 3 plus:
- More than one operating theatre/ procedure room
- Paediatric recovery separated from adult patients
- Paediatric skilled medical practitioner providing anaesthetic services
- Paediatric skilled nursing
- Access to SRN or CNS skilled in paediatrics
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| Level 5 |
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As for Level 4 plus:
- Paediatric skilled anaesthetist 24/7 for low, moderate and high risk patients
- Designated paediatric recovery area
- Medical officer on-site 24/7
- Radiology and intra-operative imaging capability for children
- Elective and emergency surgery capability
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| Level 6 |
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As for Level 5 plus:
- Multiple operating theatres and procedure rooms
- Major and complex procedures (cardiothoracic, neurosurgery and transplant)
- Teaching and research role
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Specialty medical outpatients
| Level 1 |
| No level 1 service. Please refer to a higher level. |
| Level 2 |
- Outpatient care by GP or medical practitioner
- Paediatric specialist support via statewide resource centre
- Established pathway for child protection or family/paediatric skilled social worker
- Access to generalist domiciliary nursing and/or allied health
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| Level 3 |
- Outpatient care by general paediatrician on-site or in local community
- Some paediatric specialty e-health consultation or occasional visiting specialist outpatient service
- May be some non- complex paediatric diagnostic/ procedural work by some visiting specialties e.g. endoscopy
- Access to outpatient allied health services
- Access to basic function and diagnostic equipment/facilities suitable for paediatric patients
- Integrated paediatric physician/GP and specialty service for some paediatric specialties
- Access to child protection or paediatric skilled social work
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| Level 4 |
- Range of visiting paediatric specialist outpatient consultations
- Consultation on-site or in local community
- Procedural intervention by visiting paediatric skilled specialist
- Some adult specialist services for young adult, adolescent and transitioning children
- Access to paediatric skilled allied health and nursing services
- Paediatric skilled, multi-disciplinary allied health and/ or rehabilitation teams specific to specialty requirements e.g. rehabilitation, diabetes
- Integrated paediatric physician and surgical service
- Access to some paediatric suitable diagnostic services
- Patient/family education
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| Level 5 |
- Outpatient care by range of paediatric specialists at site or in local community
- Specialised outpatient paediatric skilled allied health and nursing services
- Range of paediatric suitable diagnostic and procedural services
- Access to some function laboratories and diagnostic facilities (e.g. basic paediatric respiratory lung function/ EEG/ cardiac)
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| Level 6 |
- Complex outpatient consults by complete range of on- site paediatric specialists
- Specialised paediatric skilled allied health, technical and nursing services
- Full range of laboratory and diagnostic facilities
- Targeted patient/ family education, care coordination and/or community transition for at risk/difficult to engage cohorts
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Specialty medical
| Level 1 |
| No level 1 service. Please refer to a higher level. |
| Level 2 |
- Access to paediatric specialist advice from statewide resource
- Inpatient medical care by GP
- Established pathway for child protection or family/paediatric skilled social work
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| Level 3 |
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As for Level 2 plus:
- Inpatient medical care by paediatrician
- Access to paediatric specialist advice from statewide resource
- Paediatric trained RNs
- Access to child protection or paediatric skilled social work
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| Level 4 |
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As for Level 3 plus:
- Inpatient care by paediatrician (general), paediatric registrar, RMO
- Paediatric skilled RNs and CNS or SRN
- Access to designated paediatric skilled allied health services (varies and as required by specific specialty area)
- Patient/family education services integrated with community and/or outpatient care
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| Level 5 |
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As for Level 4 plus:
- Access to paediatric specialty inpatient care
- Undergraduate teaching and participation in research
- Paediatric specific specialist medical, nursing and allied health
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| Level 6 |
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As for Level 5 plus:
- Specialty ward areas for some paediatric specialties
- Comprehensive care, including emergency, available from on-call paediatric specialist
- Full range of hospital substitution, ambulatory and same day services
- Specialised inpatient paediatric skilled allied health services
- Sub-specialties
- Specialist SRN
- Statewide referral, decision support, consult, teaching and research role - medical, nursing and allied health disciplines
- Paediatric ICU as tertiary referral centre having extensive laboratory and clinical service facilities
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Specialty surgery outpatients
| Level 1 |
| No level 1 service. Please refer to a higher level. |
| Level 2 |
- GP service with telephone/ Telehealth paediatric advice
- Outpatient paediatric specialty support via statewide resource centre
- Established pathway for child protection or family/paediatric skilled social work
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| Level 3 |
- Visiting outpatient specialist consultations associated with surgical sessions on-site or in local community
- General non- inpatient care via visiting paediatrician on-site or within community
- Access to child protection or paediatric skilled social work
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| Level 4 |
- Visiting surgical specialist skilled in paediatrics for range of outpatient consultations on-site or in local community
- General non- inpatient care by paediatrician
- Access to some diagnostic facilities and services (audiology booth, basic lung function)
- Paediatric skilled allied health accessible in local community or on-site; varies as specific to specialty requirements
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| Level 5 |
- Outpatient care for moderately complex patients
- Access to paediatric skilled specialist allied health services specific to specialty
- Access to SRN specific to specialty as relevant
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| Level 6 |
- Complex outpatient consultation by on-site specialists skilled in paediatrics
- Specialised paediatric skilled allied health, technical and nursing services
- Statewide Telehealth referral and consultation with smaller sites
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Specialty surgery
| Level 1 |
| No level 1 service. Please refer to a higher level. |
| Level 2 |
- Uncomplicated common outpatient procedures by GP via local anaesthesia
- Access to paediatric surgical specialist advice from statewide resource
- Established pathway for child protection or family/paediatric skilled social work
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| Level 3 |
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As for Level 2 plus:
- Common same day and outpatient procedures on low risk patients in high volume paediatric surgical specialties (e.g. ENT) with paediatric skilled anaesthetist
- Short stay post- surgical inpatient care in designated paediatric beds/ ward
- Access to child protection or paediatric skilled social work
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| Level 4 |
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As for Level 3 plus:
- Common and intermediate procedures on low – moderate risk paediatric patients
- Specialist paediatric skilled anaesthetist
- Inpatient medical care by paediatrician/ registrar, RMO
- Paediatric skilled RNs and CNM
- Integrated surgical and paediatric physician service for some cases
- Paediatric skilled allied health; varies as specific to specialty requirements
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| Level 5 |
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As for Level 4 plus:
- Surgery on low to high risk paediatric patients by surgical specialist skilled in paediatrics
- Diagnostic services (as relevant)
- Paediatric skilled and specialist medical, nursing and allied health
- Access to specialist SRN
- Paediatric skilled allied health specific to specialty
- Regional referral role for some surgical specialties
- Teaching, training and some research
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| Level 6 |
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As for Level 5 plus:
- Full range of major and complex surgery; in association with other specialists
- Full range of diagnostic procedures
- Full range of ambulatory and same day services
- Emergency services
- Specialised inpatient paediatric skilled allied health services
- On-site child protection services
- Sub-specialties
- Statewide referral, advisory, consult, teaching and research role - medical, nursing and allied health disciplines
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Trauma
| Level 1 |
| No level 1 service. Please refer to a higher level. |
| Level 2 |
| No level 2 service. Please refer to a higher level. |
| Level 3 |
- Access to medical doctor advice within 30 minutes or medical doctor in attendance within 30 minutes
- Participates in the care of minor trauma
- Rural: may be the occasional need for resuscitation of a major trauma patient, with rapid transfer on
- Primary retrieval from incident site as the nearest emergency service
- Secondary retrieval by fixed wing, rotary wing to major trauma centres
- Secondary retrieval of minor trauma by fixed wing or road transport to regional trauma centres
- Initial disaster response in a multi casualty event where centre is the nearest emergency health service
- Access to ETS
- Rural trauma centres
Equivalent to Level IV RACS VMRC
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| Level 4 |
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As for Level 3 plus:
- Prompt assessment, resuscitation, emergency surgery and stabilisation of a small number of seriously injured patients and transfer on
- General surgical service and participates in the care of minor trauma
- 24/7 availability of an on duty specialist surgeon and anaesthetist and/or generalist anaesthetist
- Nurse experienced in trauma
- Access to/on-call radiology facilities
- Provision for helicopter landing nearby
- Role in management, assessment and treatment of minor trauma in multi- casualty disaster response
- Regional trauma centres
- Urban trauma centres
Equivalent to Level III RACS VMRC
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| Level 5 |
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As for Level 4 plus:
- A surgeon available in all specialties commensurate with Level 6
- 24/7 availability of neurosurgical & cardiothoracic services
- High level ICU trauma team response and operating suites with 24/7 availability
- On-site helicopter landing site
- Role in management of major trauma cases >48hrs during multi- casualty disaster response
- Metropolitan trauma centres
Equivalent to Level II RACS VMRC |
| Level 6 |
|
As for Level 5 plus:
- Full spectrum of care
- 24/7 trauma reception team
- 24/7 availability of senior consultant and general surgeon
- Appointed trauma director
- Elective and emergency surgery in neurosurgery, cardiothoracic, orthopaedics and plastics
- Lead role in the coordination and management of mass casualty and disaster preparedness scenarios
- Principal hospital for reception of inter hospital transfer of major trauma patients
- Research
- Education and fellowship training*
- Trauma systems overview
- Quality improvement program
- Data collection
- Prevention and outreach programs
- Trauma audit
- Leadership responsibilities
- Major trauma service
Equivalent to Level I RACS VMRC
* Not currently operating in WA
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