Field Triage of Injured Pts Flashcards
Why were the guidelines changed?
To ultimately achieve overall better pt outcomes
What were influencing factors for changing the guidelines?
- New research since 2011
- EMS input
What key factors are quickly affected?
- How the pt is evaluated or triaged
- What to TX
- Where the pt should be transported to
- Reduced time in decision making when it comes to TX & transport destination
- Prevents under-triaging & over-triaging
5 Systemic Reviews were implemented in the Update
- Motor GCS vs. total GCS
- Out of hospital circulatory & respiratory measures
- MOI & Special considerations
- Overall guideline performance
- Rigorous process for adding or removing criteria
Old Format compared to the New
- Too complex
- Some topics were too generalized
- Time consuming for EMS providers
New Format compared to the Old
- Consolidated into 2 categories based on risk of injury
- More clarification on specific items
- Flows more naturally w/ how information is received
- Easier to implement
Simplicity in it’s use did not detract from it effectiveness, as every update is backed by new findings on what effects pt’s survivability
How is the Criteria Divided
RED = High risk for serious injury
(Level 1 Trauma Criteria)
Yellow = Moderate risk for serious injury (Any Trauma Center Criteria)
How is the Red Criteria Divided?
- Injury Pattern
- Mental Status & VS
Injury Patterns
New
- Active bleeding requiring a tourniquet or wound packing w/ continuous pressure
Modified
- Penetrating injuries to head, neck, torso, & proximal extremities
- Skull deformity, suspected skull fracture
- Suspected spinal injury with new motor or sensory loss
- Chest wall instability, deformity, or suspected flail chest
- Suspected pelvic fracture
- Suspected fracture of two or more proximal long bones
Unchanged
- Crushed, degloved, mangled, or pulseless extremity
- Amputation proximal to wrist or ankle
Mental Status & VS (ALL PTs)
MODIFIED
- Unable to follow commands (motor GCS < 6)
NEW
- RR < 10 or > 29 breaths/min
- Respiratory distress or need for respiratory support
- Room-air pulse oximetry < 90%
- Shock Index >1 for ages 10>
Hypotension
Age 0–9 years
* SBP < 70mm Hg + (2 x age in years)
Age 10–64 years
* SBP < 90 mmHg
Age ≥ 65 years
* SBP < 110 mmHg
Mental Status in Peds
Nonverbal pediatric patients may be too young to follow commands
In preverbal children, they should be moving spontaneously and purposefully
May inquire from caregiver whether the child appears to be at their baseline
When in doubt, transport to the highest-level trauma center
How is the Yellow Criteria Divided?
MOI
EMS Judgement
MOI
NEW
- Child (Age 0-9 years) unrestrained or in unsecured child safety seat
MODIFIED
- Significant intrusion (including roof)
> 12 inches occupant site
or
> 18 inches any site
or
Need for extrication of the entrapped patient (added extrication)
- Rider separated from transport vehicle – not just “ejection from automobile”
- Pedestrian/Bicycle rider thrown, run over, or with significant impact (no speed limit)
- Fall from height > 10 feet
(all ages now instead of different heights or “times the height of…”)
Unchanged
- Partial or complete ejection
- Death in passenger compartment
- Vehicle telemetry data consistent with severe injury
EMS Judgement
- Replacing Special Considerations
New
- Low level falls in young children (age ≤ 5 years) or older adults (age ≥ 65 years) with significant head impact
- Suspicion of child abuse
- Special, high resource healthcare needs
Modified
- Anticoagulation use (Studies were inconclusive, not much difference)
Unchanged
- Pregnancy > 20 weeks
- Burns in conjunction with trauma
- Children should be triaged preferentially to pediatric
capable centers
If concerned, take to a trauma center
