1. These criteria should prompt bypass or immediate transfer to definitive care facilities. Startship (paeds) and
    Auckland (adults) is the definitive care facility for most multi–trauma.
  2. This is a guideline only. It does not replace clinical judgement.
  3. All transfers must be safe and confer clinical benefit to the patient.
  4. Notification between senior transferring and accepting medical staff precedes all transfers.
  5. These guidelines have been agreed by all involved clinicians and endorsed by the four Northern Region CMOs.

Trauma inter-hospital transfer guidelines for Kaitaia, Dargaville and Bay of Islands Hospitals

ConditionHospital to refer toComment
Traumatic Brain Injury
GCS≥ 13 +/- concussion, not resolving Whangarei or Starship/Auckland D/w Whangarei ED SMO on 021 672 512
GCS 9 - 12 Whangarei or Starship/Auckland D/w Whangarei ED SMO on 021 672 512
GCS <9 and/or open brain injury e.g. compound skull fracture Starship/Auckland Paeds: Call Starship
Adults: Call 0800 4 TRAUMA
Spine
Suspect spinal injury, no motor deficit   X-ray and d/w Whangarei Orthopaedic team and/or refer to
Whangarei Hospital for further imaging as needed.
Spinal cord injury:
• Isolated with motor deficit
• Multitrauma but not TBI or chest injuries
Paeds - Starship
Adults - Middlemore
Refer to Supra-regional Spinal Cord Injury Guidelines
Spinal cord injury - with other major injuries such as TBI or chest Paeds - Starship
Adults - Middlemore or Auckland
For adult patients d/w Intensive Care at Middlemore to determine whether appropriate to transfer to Middlemore, otherwise transfer to Auckland by calling 0800 4 TRAUMA
Vascular Injuries
Blunt Carotid/Vertebral/Thoracic Aortic Injuries Starship/Auckland Paeds: Call Starship
Adults: Call 0800 4 TRAUMA
Burns/Plastics
Burns > 20% , or less but affects special sites Middlemore Refer to Burn Guideline
D/w Burn Service at Middlemore on 09 250 3800, and fax referral to 09 276 0114
Burns <20%   Refer to Burn Guideline
D/w Burn Service at Middlemore if grafting required
Degloving of face or other special sites or extensive / complex facial lacerations Middlemore D/w Plastic Surgical Registrar at Middlemore on 021 784 057
Maxillo Facial
All Max Fax injury - Paeds Starship  
Isolated Max Fax injury - Adults Middlemore D/w Max Fax (021 292 1593) or
Plastic Surgical Registrar (021 784 057) at Middlemore
Max Fax injury with TBI or chest injuries - Adults Auckland Adults: Call 0800 4 TRAUMA
Chest
All paediatric chest injuries - serious Starship  
Penetrating chest injury - with shock +/- haemodynamic instability Starship /Auckland If (adult) patient has > 1,500ml blood loss in chest drain,
not responding to resusication, needs urgent thoracotomy. Transfer when stabilised. Call 0800 4 TRAUMA
Multiple rib #, flail chest/ sternum injury Whangarei  
Pulmonary contusions/Pneumothorax/Haemathorax Whangarei  
Abdominal Injuries
Paediatric simple abdominal trauma Whangarei  
Paediatric complex abdominal trauma Starship  
Penetrating abdominal Injury Whangarei or Auckland If transfer to Auckland required, call 0800 4 TRAUMA
Blunt abdominal injury Whangarei  
Complex liver injury Auckland Call 0800 4 TRAUMA
Perineal Injury Whangarei  
Special limb injuries
Upper limb with major nerve injury, +/- arterial injury Middlemore Call Plastic Surgical Registrar at Middlemore on 021 784 057
Upper limb with arterial injury (but no nerve injury) Starship / Auckland Paeds: Call Starship
Adults: Call 0800 4 TRAUMA
Upper limb - amputation of viable digit (excluding simple terminalisation) or partial limb amputation Middlemore Call Plastic Surgical Registrar at Middlemore on 021 784 057
Mangled lower limb with tissue loss   D/w Orthopaedic Service at Whangarei Hospital to determine whether to transfer to Whangarei or Middlemore
Lower limb - penetrating injury with major nerve injury +/- arterial injury Middlemore Call Plastic Surgical Registrar at Middlemore on 021 784 057
Lower limb
• penetrating injury with arterial injury (but no nerve injury)
• blunt injury with ischaemia +/- nerve injury
  D/w Orthopaedic Service at Whangarei Hospital to determine whether to transfer to Whangarei or Auckland
Orthopaedic
Open or complex pelvic # +/- haemodynamic instability Starship/Auckland Paeds: Call Starship
Adults: Call 0800 4 TRAUMA
Two or more long bone #, acetabulum # Whangarei  
Urology
Ruptured kidney or urethral injuries Starship/Whangarei