23rd February 2018, Volume 131 Number 1470

Jesse Whitehead, Matt Roskruge, Colin Tan, Alistair Smith, Grant Christey

In 2013, injuries accounted for 8% of New Zealand’s morbidity and mortality (disability-adjusted life years) and were the second greatest cause of morbidity and mortality among children (10%) and youth…

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This study evaluates the geospatial movement of major trauma patients from pre-hospital locations to hospitals in the Midland region and compares the actual destination to the optimal destination defined for patients meeting clinical criteria defined in the national major trauma triage policy. This study has been conducted prior to implementation of the Midland Pre-Hospital Major Trauma Destination Matrix and will be repeated in 2019 to evaluate change in processes resulting from the “Midland Matrix”.



Pre-hospital triage strategies aim to identify the type and extent of patient injuries and ensure that they are transferred to the most appropriate trauma centres. Despite the importance of appropriate pre-hospital transport, there is little evidence base to assist medical staff on optimal destination policy for emergent pre-hospital transport. This paper explores the spatial relationship of patient transfers prior to the implementation of the Midland Pre-Hospital Trauma Destination Matrix in New Zealand, and is a retrospective view of practice against a destination policy that was applied after the study period.


We use data obtained from the Midland Trauma Registry merged with Global Positioning System (GPS) data from St John and Land Information New Zealand Data Service on major trauma occurring in 2014 and 2015. Using ArcGIS, data were analysed for spatial relationships between factors associated with major trauma events and pre-hospital transportation.


In the retrospective analysis of 162 major trauma patients, 107 (66%) were transported to a hospital that matched the destination specified in the Matrix, and 55 (34%) were transported to a non-Matrix designated hospital.


Approximately one-third of patients were not directly transported to the preferred definitive care hospital subsequently defined in the Midland Pre-Hospital Trauma Destination Matrix. Ongoing monitoring of the pre-hospital transportation system and the implementation of a formal pre-hospital transport policy may improve the efficiency of the Midland Trauma System. Future studies should examine the possible reasons for variations in triage decisions across the Midland Region.

Author Information

Jesse Whitehead, Midland Trauma System, Waikato DHB, Hamilton;
Matt Roskruge, School of Economics and Finance, Massey University, Auckland;
Colin Tan, St John, Auckland; Alistair Smith, Midland Trauma System, Waikato DHB, Hamilton;
Grant Christey, Midland Trauma System, Waikato Hospital, Hamilton; Waikato Clinical School, University of Auckland, Auckland.


The authors would like to acknowledge the following people for their help with the study and in the preparation of this manuscript: Sabrina Liu, Senior Performance Analyst, St John; Stephen Holmes, Biostatistician, Midland Trauma System. The authors also acknowledge the University of Waikato for the funding through a Summer Scholarship.


Dr Grant Christey, Midland Trauma System, Waikato Hospital, Hamilton.

Correspondence Email


Competing Interests



  1. Ministry of Health. Health Loss in New Zealand 1990–2013: A report from the New Zealand Burden of Diseases, Injuries and Risk Factors Study. Wellington: Ministry of Health; 2016.
  2. Celso B, Tepas J, Langland-Orban B, Pracht E, Papa L, Lottenberg L, et al. A systematic review and meta-analysis comparing outcome of severely injured patients treated in trauma centers following the establishment of trauma systems. J Trauma Acute Care Surg. 2006; 60(2):371–8.
  3. Faul M, Wald MM, Sullivent EE, Sasser SM, Kapil V, Lerner EB, et al. Large cost savings realized from the 2006 Field Triage Guideline: reduction in overtriage in US trauma centers. Prehosp Emerg Care. 2012; 16(2):222–9.
  4. Gabbe BJ, Lyons RA, Fitzgerald MC, Judson R, Richardson J, Cameron PA. Reduced population burden of road transport-related major trauma after introduction of an inclusive trauma system. Ann Surg. 2015; 261(3):565–72.
  5. O’Connor RE. Trauma triage: concepts in prehospital trauma care. Prehosp Emerg Care. 2006; 10(3):307–10.
  6. Cox S, Currell A, Harriss L, Barger B, Cameron P, Smith K. Evaluation of the Victorian state adult pre-hospital trauma triage criteria. Injury. 2012; 43(5):573–81.
  7. Wahlin RR, Ponzer S, Skrifvars MB, Lossius HM, Castrén M. Effect of an organizational change in a prehospital trauma care protocol and trauma transport directive in a large urban city: a before and after study. Scand J Trauma Resusc Emerg Med. 2016; 24(1):1–9.
  8. Mulholland SA, Gabbe BJ, Cameron P. Is paramedic judgement useful in prehospital trauma triage? Injury. 2005; 36(11):1298–305.
  9. Kloot K, Salzman S, Kilpatrick S, Baker T, Brumby SA. Initial destination hospital of paediatric prehospital patients in rural Victoria. Emerg Med Australia. 2016; 28(2):205–10.
  10. Fitzharris M, Stevenson M, Middleton P, Sinclair G. Adherence with the pre-hospital triage protocol in the transport of injured patients in an urban setting. Injury. 2012; 43(9):1368–76.
  11. Kennedy MP, Gabbe BJ, McKenzie BA. Impact of the introduction of an integrated adult retrieval service on major trauma outcomes. Emerg Med J. 2015; 32(11):833–9.
  12. Mans S, Folmer ER, de Jongh MA, Lansink KW. Direct transport versus inter hospital transfer of severely injured trauma patients. Injury. 2016; 47(1):26–31.
  13. Boschini LP, Lu-Myers Y, Msiska N, Cairns B, Charles AG. Effect of direct and indirect transfer status on trauma mortality in sub Saharan Africa. Injury. 2016; 47(5):1118–22.
  14. Cassidy TJ, Edgar DW, Phillips M, Cameron P, Cleland H, Wood FM. Transfer time to a specialist burn service and influence on burn mortality in Australia and New Zealand: A multi-centre, hospital based retrospective cohort study. Burns. 2015; 41(4):735–41.
  15. Hsiao KY, Lin LC, Chou MH, Chen CC, Lee HC, Foo NP, et al. Outcomes of trauma patients: direct transport versus transfer after stabilisation at another hospital. Injury. 2012; 43(9):1575–9.
  16. Pickering A, Cooper K, Harnan S, Sutton A, Mason S, Nicholl J. Impact of prehospital transfer strategies in major trauma and head injury: Systematic review, meta-analysis, and recommendations for study design. J Trauma Acute Care Surg. 2014; 78(1):164–77.
  17. Cameron PA, Gabbe BJ, Smith K, Mitra B. Triaging the right patient to the right place in the shortest time. Br J Anaesth. 2014; 113(2):226–33.
  18. Major Trauma National Clinical Network. New Zealand Major Trauma Minimum Dataset. Major Trauma National Clinical Network, 2015.
  19. Civil I. Trauma: still a problem in New Zealand. N Z Med J. 2004; 117(1201):1–3.
  20. Paice R. An overview of New Zealand’s trauma system. J Trauma Nursing. 2007; 14(4):211–3.
  21. Christey GR. Trauma care in New Zealand: It’s time to move ahead. World J Surg. 2008; 32(8):1618–21.
  22. Kejriwal R, Civil I. Time to definitive care for patients with moderate and severe brain injury-does a trauma system matter? . N Z Med J. 2009; 112(1302):40–6.
  23. Civil I. A national trauma network: now or never for New Zealand. N Z Med J. 2010; 123(1316):9–10.
  24. Major Trauma National Clinical Network. Annual Report 2015–2016. Major Trauma National Clinical Network, 2016.
  25. Ministry of Health. Roadside to bedside: a 24-hour clinically integrated acute management system for New Zealand. Wellington: Ministry of Health; 1999.
  26. National Spinal Cord Impairment Governance Committee. New Zealand Spinal Cord Injury Destination Policy. Ministry of Health, 2015.
  27. Royal Australasian College of Surgeons New Zealand Trauma Committee. Guidelines for a structured approach to the provision of optimal trauma care In: Surgeons RACo, editor. 2012.
  28. Midland Trauma System. 2015–2016 Annual Report. Hamilton, New Zealand: Waikato District Health Board, 2017.
  29. Vogel M. The Modifiable Areal Unit Problem in Person-Context Research. Journal of Research in Crime and Delinquency. 2016; 53(1):112–35.
  30. American College of Surgeons Committee on Trauma (ACS-COT). Resources for optimal care of the injured patient. Chicago (IL): The Committee; 2014.
  31. Ministry of Health. New Zealand Health Strategy Future Direction. Wellington: Ministry of Health; 2016.


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