Appendix B. Trauma Triage (Destination

Question 1

STEP 1: VITALS & Level of Consciousness

Take Pt to Nearest Level I/II Trauma Center within 30min via Ground OR Air

Answer 1

1. GCS <12, or
2. Systolic BP <90mmHg, or
3. Respiratory Rate <10 or >29breaths/min (<20 or >29/breaths/min in infants <1year), or
4. Need for Ventilatory Support

Question 2

STEP 2: Assess Anatomy of Injury

Take Pt to Nearest Level I/II Trauma Center within 30min via Ground OR Air

Answer 2

1. All Penetrating injuries to Head, Neck, Torso, or Extremities Proximal to Elbow or Knee
2. Chest Wall Instability or Deformation (e.g. Flail Chest)
3. Two or More Proximal Long-Bone Fracture (Fx)
4. Crushed, De-gloved, Mangled, or Pulseless Extremity
5. Amputation Proximal to Wrist or Ankle
6. Pelvic Fractures
7. Open or Depress Skull Fx
8. Paralysis

Question 3

STEP 3: Assess MOI & Evidence of High-Energy Impact

Take Pt to Nearest Appropriate Trauma Center within 30min via Ground OR Air

Answer 3

1. FALLS:
   a. ADULTS/CHILDREN >15years Old: >20ft fall (one story = 10ft)
   b. CHILD <15years Old: >10ft or 2-3 x the height of the child
2. HIGH-RISK VEHICLE CRASH:
   a. Intrusion, Including Roof: >12in occupant site or >18in any site
   b. Ejection (Partial or Complete) From Vehicle
   c. Death in Same Passenger Compartment
   d. Vehicle Telemetry Data Consistent with High-Risk of Injury
3. VEHICLE vs. PEDESTRIAN/BICYCLIST: Thrown, Run Over, or with Significant (>20mph) Impact
4. MOTORCYCLE CRASH: >20mph

Question 4

STEP 4: Assess Special Patient or System Considerations

Contact medical control or receiving facility, and consider transport to a trauma center or a specific resource hospital

Answer 4

1. OLDER ADULTS:
   a. Risk of Injury or Death Increases After Age 55 years
   b. Systolic BP >110 May Represent Shock After Age 65 Years
   c. Low Impact Mechanisms (e.g. ground level fall) May Result in Severe Injury
2. CHILDREN:
   a. Should be Triaged Preferentially to Pediatric-Capable Trauma Centers
3. ANTICOAGULATION and BLEEDING DISORDERS:
   a. Patients with Head Injury are at High Risk for Rapid Deterioration
4. BURNS:
   a. Without Other Trauma Mechanism: Triage to Burn Facility
   b. WITH Trauma Mechanism: Triage to Trauma Center
5. PREGNANCY >20 WEEKS
6. EMS PROVIDER JUDGEMENT

Question 5

If NO to STEPS 1-4

Answer 5

Transfer according to local protocol.

NOTE: When in Doubt, Transport to a Trauma Center!