Trauma Alert

Question 1

Adult Trauma Alert - Physiologic Criteria

Answer 1

GCS less than 14
Systolic BP less than 90
RR less then 10 or greater than 29

Question 2

Pediatric Trauma Alert

Answer 2

GCS less than 14
Systolic BP less tan 60 in 6y/o and under
Systolic BP less than 90 for older than 6
RR less than 10 or greater than 29
RR less then 20 for infants less than 1 y/o

Question 3

Adult Trauma Alert - Anatomic Criteria

Answer 3

A. Penetrating injuries to head, neck, chest, back, abdomen, groin, or extremities proximal to the elbow or knee.
B. Two (2) or more proximal long bone fractures.
C. Traumatic paralysis or paresthesia.
D. Flail or crushed chest.
E. Amputations proximal to the wrist or ankle.
F. Suspected pelvic fractures. (See Section VII.)
G. Central Nervous System (CNS) changes witnessed by prehospital personnel that include the following:
1. Post traumatic seizure.
2. Transitory or prolonged loss of consciousness (LOC).
3. Hemiparesis.
H. Crushed, degloved or mangled extremity.
I. Open or depressed skull fracture.

Question 4

Trauma Alert - Mechanism of Injury Criteria High Risk Crash

Answer 4

A. High-Risk Auto Crash as evidenced by:

1. Estimated impact speed of more than forty (40) mph
2. Major auto deformity greater than twelve (12) inches occupant site or greater than eighteen (18) inches any other site.
3. Significant structural damage to the vehicle caused by contact with patient’s body, such as damage to the steering wheel and/or column, windshield, etc.
4. Ejection (partial or complete) from the vehicle.
5. Death of a passenger in the same vehicle, who suffered the same or similar mechanism.
6. Prolonged extrication is required to free the victim.
7. Rollover with unrestrained occupant.

Question 5

Trauma Alert - Mechanism of Injury Criteria Falls

Answer 5

B. Falls
1. Adults: more than fifteen (15) feet (one story is equal to 10 feet).
2. Pediatric: greater than 10 feet or twice the height of a child that is under six (<6) years old.
C. Auto vs. pedestrian/bicyclist thrown, run over, or with significant (more than twenty (20) mph) impact.
D. Motorcycle crash at greater than twenty (20) mph
E. Cycle crash with rider thrown a significant distance to sustain probable injury. The term “cycle” may include motorcycle, bicycle, ATV, etc.

Question 6

Trauma Alert - Special Considerations

Answer 6

A. There are other factors that might influence destination which patients should be treated in Trauma Centers. The following should be considered in prehospital trauma triage:
1. Age: Patients over age fifty-five (55) have an increased risk of death from even moderately severe injuries.
2. Pediatric Considerations: Trauma triage of the pediatric patient requires that the practitioner be knowledgeable of the uniqueness of children’s anatomy and their physiologic needs. Interventions must be varied to meet the subtle anatomic and physiologic differences between children and adults. Children sustain more head and multi-systems injuries that do adults due to the fact that traumatic force applied to a child’s body is distributed over less body mass.
3. Co-morbid Factors: The presence of, cardiac, respiratory, or metabolic disease are also factors that may merit the triage of patients with moderately severe injury to Trauma Centers.
4. Alcohol, drug influence and/or foreign language speaking patients are examples of factors that may make an accurate neurological assessment difficult. The paramedic should maintain a higher index of suspicion in these cases.
5. Patients on anti-coagulants or with bleeding disorders.
6. Patients with end stage renal disease requiring dialysis.
7. Time-sensitive extremity injury.
8. EMS provider judgment to transport patient to a trauma center.
9. Burns (see Section IX)

Question 7

Major Burn Criteria

Answer 7

A. Patients with burn injuries are to be identified as major burn criteria if any of the following are present:
1. Partial-thickness burns greater than 10% of the total body surface area
2. Burns that include the face, hands, feet, genitalia, perineum, or major joints
3. Third-degree burns
4. Electrical burns, including lightning injury
5. Chemical burns
6. Inhalation injury
7. Burn injury in patients with pre-existing medical disorders that could complicate management, prolong recovery, or affect mortality
B. Transport all identified major burn patients to a designated burn center.
C. Patients who do not meet major burn criteria should be transported to an appropriate acute care hospital with emergency services.
D. Patients who meet the major burn criteria and who also meet trauma alert criteria and the traumatic injuries poses a greater risk of morbidity or mortality shall be transported to: (1) the closest trauma center to the incident location by total emergency ambulance transport time: and (2) that is accepting emergency ambulance patients.