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Field trauma triage
From WikEM
Contents
Background
- The Centers for Disease Control and Prevention (CDC) Trauma Triage Guidelines, composed by the American College of Surgeons' Committee on Trauma and the National Highway Traffic Safety Administration, help EMS providers triage trauma patients to the proper facility. These guidelines offer patient-specific criteria used for determining which facility a patient sustaining traumatic injuries needs to provide the level of definitive treatment required.
Decision Rules
If step one or two criteria met, transport to highest level of care trauma center. If step three criteria met, transport to trauma center, but not necessarily highest level. If step four criteria met, transport to trauma center or hospital capable of timely and thorough evaluation. When in doubt, transport to a trauma center
Step One: Physiologic Criteria
- Glasgow Coma Scale ≤13, or
- SBP of <90 mmHg, or
- Respiratory rate of <10 or >29 breaths per minute (<20 in infant aged <1 year), or need for ventilatory support
Step Two: Anatomic Criteria
- All penetrating injuries to head, neck, torso, and extremities proximal to elbow or knee
- Chest wall instability or deformity (e.g. flail chest)
- Two or more proximal long-bone fractures
- Crushed, degloved, mangled, or pulseless extremity
- Amputation proximal to wrist or ankle
- Pelvic fractures
- Open or depressed skull fractures
- Paralysis
Step Three: Mechanism of Injury
- Falls
- Adults: >20 feet (one story = 10 feet)
- Children: >10 feet or two to three times the height of the child
- High-risk auto crash
- Intrusion, including roof: >12 inches occupant site; >18 inches any site
- Ejection (partial or complete) from automobile
- Death in same passenger compartment
- Vehicle telemetry data consistent with a high risk for injury
- Automobile versus pedestrian/bicyclist thrown, run over, or with significant (>20 mph) impact
- Motorcycle crash >20 mph
Step Four: Special Considerations
- Older adults
- Risk for injury/death increases after age 55 years
- SBP <110 might represent shock after age 65 years
- Low impact mechanisms (e.g., ground-level falls) might result in severe injury
- Children
- Should be triaged preferentially to pediatric capable trauma centers
- Anticoagulants and bleeding disorders
- Patients with head injury are at high risk for rapid deterioration
- Burns
- Without other trauma mechanism: triage to burn facility
- With trauma mechanism: triage to trauma center
- Pregnancy >20 weeks
- EMS provider judgment
