Trauma Triage in the Field

Aka: Trauma Triage in the Field, EMS Trauma Triage Protocol

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II. Indications: Level I or Level II Trauma Center - Immediate transport

  1. EMS Criteria based on Trauma Primary Survey
    1. Glasgow Coma Scale (GCS) <13
    2. Systolic Blood Pressure <90 mmHg
    3. Respiratory Rate <10 or >29 breaths/min (or in age <1 year, respirations<20 breaths/min)
    4. Requiring Ventilatory support
  2. EMS Criteria based on injuries identified on Secondary Survey
    1. Penetrating injury to head, neck, torso or proximal extremity (above knee or above elbow)
    2. Two or more proximal long bone Fractures
    3. Crushed, degloved, mangled or pulseless extremity
    4. Extremity Amputation proximal to the wrist or ankle
    5. Pelvic Fracture
    6. Open or depressed Skull Fracture
    7. Paralysis

III. Indications: Closest hospital emergency department that can manage Trauma (Levels I to IV)

  1. EMS provider judgement
  2. EMS Criteria based on mechanism of injury
    1. Falls
      1. Adult: >20 feet (2 stories)
      2. Child: >10 feet or fall from more than twice the height of the child
    2. High-risk Motor Vehicle Accident
      1. Intrusion into passenger compartment (including roof) >12 inches
      2. Ejection from vehicle (even if partial ejection)
      3. Death in same passenger compartment
      4. High risk of injury based on vehicle telemetry data
      5. Motor vehicle versus pedestrian or bicyclist (thrown, run over or with impact at >20 MPH)
      6. Motorcycle accident at >20 MPH
  3. EMS Criteria based on comorbidity or injury
    1. Trauma in Children
      1. Pediatric Trauma centers are preferred when available
    2. Trauma in Pregnancy > 20 weeks
      1. Vital Signs may be unreliable in predicting serious injury
    3. Trauma in Older Adults (risk increases after age 55 years)
      1. Serious injury may occur with falls at ground level
      2. Vital Signs may be unreliable in predicting serious injury
    4. Burn Injury
      1. Burn center is preferred if isolated Burn Injury (especially if >20% involved surface area)
      2. Trauma Center is preferred if other injuries accompany the Burn Injury
    5. Anticoagulation or Bleeding Disorders
      1. Head Injury is associated with significant risk of Intracranial Bleeding

IV. References

  1. (2012) ATLS, 9th Ed, American College of Surgeons, Trauma Committee, p. 5

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