Trauma Triage and Destination Guidelines

Question 1

List physiological criteria for Major Trauma (adult and pediatric) and appropriate bypass to lead trauma hospital

Answer 1

• Adults (any of the following)
  
  • SBP <90
  • RR <10 or >30
  • GCS ≤13
• Pediatrics
  
  • Abnormal SBP, RR, or HR for age
  • GCS ≤13

Question 2

List anatomical criteria for Major trauma bypass

Answer 2

• Open or Depressed skull fracture
• New paralysis or neurological deficits
• Major penetrating injury
• Facial injury with potential airway compromise
• Two or more proximal long bone fractures
• Crushed, degloved, mangled, or pulseless extremity
• Amputation proximal to wrist or ankle
• Chest wall instability or deformity (Flail chest)
• Major Burns
• Unstable Pelvis

Question 3

List Mechanism criteria for major trauma bypass

Answer 3

• Falls >6m for adults
• Falls >3m for pediatrics, or 2-3 time body height
• Significant MVA
  
  • Intrusion, ejection, death in the vehicle
• Pedestrian, bicycle, or motorcycle collision at >30kph

Question 4

Describe special considerations for major trauma bypass

Answer 4

• Elderly patients
• SBP <110 in patients >65YO
• Anticoagulation
• Pregnancy >20wks
• Pediatric patients should be preferentially transferred to pediatric lead trauma hospitals

Question 5

What are the firs three special presentations requiring consideration in major trauma transport decisions?

Answer 5

• Failed airway?
  
  • Always go to nearest ED
• Blunt traumatic cardiac arrest?
  
  • Call for likely discontinuation
• Pentrating traumatic cardiac arrest?
  
  • Immediate transport to lead trauma center if <15minutes; OR
  • Transport to nearest ED if <15minutes; OR
  • Call for likely discontinuation orders

Question 6

State wether the following finding, in isolation, necessitates classification as MAJOR trauma:

Single femur fracture

Answer 6

No!

two or more proximal long bone fractures is the anatomical criterion

Question 7

State wether the following finding, in isolation, necessitates classification as MAJOR trauma:

GCS = 13

Answer 7

Yes!

GCS <14 with trauma = MAJOR trauma

Question 8

State wether the following finding, in isolation, necessitates classification as MAJOR trauma:

SBP = 99mmHg

Answer 8

No!

Physiologic criterion is SBP<90mm Hg

Question 9

State wether the following finding, in isolation, necessitates classification as MAJOR trauma:

Midline tenderness on NEXUS exam

Answer 9

No!

Meets NEXUS criteria, but not major trauma.