FTTG Flashcards
What is the Field Trauma Triage Standard (FTTS)?
Detailed criteria that indicate when patients should be transported to a LTH and/or be transported utilizing a Helicopter Emergency Medical Service (HEMS).
Reduce delays so that patients receive the focused care they need.
Who collaborates on the FTTS?
Collaboration includes: Centre for Disease Control (CDC), MOH LTC EHSB, Medical Advisory Committee (MAC), Ontario Base Hospital Group (OBHG), Ornge, Ontario Association of Paramedic Chiefs (OAPC), Ontario Trauma Advisory Committee.
Who plays a part in the FTTS process?
Participants include Caller, CACC Dispatcher, Ornge Dispatcher, Paramedic, Flight Paramedic, Flight Crew.
What are the four steps in the FTTS decision process?
Step 1: Physiological, Step 2: Anatomical, Step 3: Mechanism of Injury, Step 4: Special Considerations.
What happens if the answer is ‘yes’ in the FTTS decision process?
If the criteria in a particular step are met, the paramedic may take the patient directly to the LTH if the land ambulance transport time is < 30 minutes.
If the paramedic is unable to successfully maintain the airway or the patient is unlikely to survive transport to the LTH, the patient MUST be transported to the closest Emergency Department (ED).
What are the criteria for Step 1 - Physiological?
Any 1 of the following: LOA, Patient does not follow commands, Systolic Blood Pressure < 90 mmHg, Respiratory Rate < 10 or >= 30 BPM or need for ventilatory support (<20 in infant aged < 1 year).
What are the criteria for Step 2 - Anatomical?
Any 1 of the following: All penetrating injuries to the head, neck, torso and extremities proximal to elbow or knee, Chest wall instability or deformity, Two or more proximal long bone fractures, Crushed, de-gloved, mangled or pulseless extremity, Amputation proximal to wrist or ankle, Pelvic fractures, Open or depressed skull fractures, Paralysis.
What are the criteria for Step 3 - Mechanism of Injury?
Any 1 of the following: Falls (adults >= 6 metres, children <15 >= 2-3 times height), High Risk Auto Crash (Intrusion >= 0.3 metres occupant site, Ejection from automobile, Death in same passenger compartment, Vehicle telemetry data consistent with high risk injury), Auto vs. pedestrian/bicyclist with significant impact, Motorcycle crash of >= 30 km/hr.
What is the importance of Steps 3 and 4 criteria?
The criteria used for bypass to a LTH in Steps 3 and 4 are not absolute; they indicate the potential for significant injury or the need for other support services at the LTH.
What is Step 4 in the transport process?
Step 4 involves Special Considerations for patient transport to a LTH.
Under what criteria can patients be transported to a LTH?
Patients may be transported to a LTH if specific criteria have been met.
What role does paramedic judgement play in patient transport?
Paramedic judgement can help determine the destination for patient transport.
What is the significance of local Patient Priority System Bypass agreements?
Local Patient Priority System Bypass agreements can assist in determining the destination.
What is a special consideration for older adults in emergency situations?
The risk of injury or death increases after age 55. A systolic blood pressure (SBP) <110 may represent shock after age 65.
How should children be triaged in emergencies?
Children should be triaged preferentially to a pediatric capable center.
What are some special considerations in emergency situations?
- Anticoagulant and bleeding disorders
- Burns (with trauma mechanism)
- Pregnancy >=20 weeks
Scenario:
50-year-old male found unresponsive after a fall from a ladder.
GCS: 7, BP: 88/60 mmHg, RR: 8 BPM, requiring ventilatory support.
Meets Step 1 Physiological Criteria: Altered LOA, hypotension, and abnormal RR.
Action:
Transport to the closest ED due to the need for immediate airway management.
Scenario:
28-year-old male with a gunshot wound to the chest.
BP: 92/58 mmHg, HR: 120 BPM.
Meets Step 2 Anatomical Criteria: Penetrating trauma to the torso.
Action:
Bypass ED and transport directly to LTH (land transport <30 minutes).
Scenario:
35-year-old male involved in a high-speed MVC.
Partial ejection from the vehicle, complaining of severe back pain.
Meets Step 3 Mechanism Criteria: Partial ejection.
Action
Transport to LTH or activate HEMS based on distance.
Scenario:
68-year-old female who fell from standing height.
BP: 108/64 mmHg, reports hip pain with deformity.
Meets Step 4 Special Considerations: High risk of injury after age 55.
Action:
Transport to LTH due to potential for pelvic fracture.
Scenario:
12-year-old struck by a vehicle at 40 km/hr.
Thrown 5 meters and complaining of abdominal pain.
Meets Step 3 Mechanism Criteria: Auto vs. pedestrian with high-speed impact.
Action:
Transport to a pediatric-capable trauma center.
Scenario:
4-year-old male with a fall from a height 3x his body height.
GCS: 13, possible head injury.
Meets Step 4 Special Considerations: Pediatric fall from height.
Action:
Transport to a pediatric-capable trauma center.
Scenario:
40-year-old male with burns and associated MVC trauma.
Stable vitals but extensive burns to the chest and arms.
Meets Step 4 Special Considerations: Burns with trauma mechanism.
Action:
Transport to LTH with burn management capability.
Scenario:
72-year-old female on anticoagulants involved in a low-impact fall.
Complains of headache and dizziness.
Meets Step 4 Special Considerations: Anticoagulant use with fall.
Action:
Transport to LTH for potential hemorrhage.
Scenario:
60-year-old male found unconscious after a fall down stairs.
GCS: 5, BP: 82/54 mmHg, RR: 36 BPM.
Meets Step 1 Physiological Criteria: Altered LOA, hypotension, and tachypnea.
Action:
Transport to closest ED due to airway management needs.
