A critical element in matching health care resources to severity of injury is the ability to categorise hospitals and other location based providers of injury care according to their capabilities. This process has been undertaken in other countries and resulted in a description of “levels of care”. A principle underlying such categorisation is that any given facility should receive enough trauma patients to be able to maintain the skills, experience and expertise of both the staff and system.
In some respects the relative singularity of location to which trauma cases can be taken in a given geographic area
makes the description of levels of care somewhat irrelevant in the NZ setting. However the Ministry of Health has undertaken such a levelling exercise. The subsequent description of levels of care largely fitted the existing healthcare
delivery landscape and did not result in changes in practice. Nearly 10 years on, inter-hospital transfers are more common but are often based on the geographical address of the patient’s residence, rather than the initial severity of their injuries. The rapid, early transfer of patients due to severity or injury type to the most appropriate hospital is not an integral part of early patient management protocols in many institutions. The suspicion (unvalidated because of the absence of a national trauma registry) exists that improvements in patient care might be possible if more inter-hospital transfer of cases of severe injury occurred. The delivery of hospital based trauma care in NZ occurs at the following levels.