Trauma Triage Guidelines

Question 1

Step 1 - Physiological

Answer 1

Step 1 is to allow for measurement of critically inj’d pts LOC and vitals

These indicators directly demonstrate w/ high predictive value the severity of inj and the need to be preferentially transported to a Lead Trauma Hospital (LTH) for a higher level of care

If unable to successfully manage the airway in the trauma pt - the pt should be transported to the nearest ED

Question 2

Step 1 - Criteria

Answer 2

Adult Trauma Patient

• GCS =< 13
• Systolic BP <90
• RR <10 or >30 or need for ventilatory support

Question 3

Step 1 - If Criteria Not Met

Answer 3

Proceed to Step 2
In certain cases, the distance or transport time from scene to LTH may be too great given the geographical challenges within the province.

As such, regional destination guidelines may dictate that patients who meet physiological criteria be initially transported to the nearest emergency department.

CliniCall or EPOS physician consultation can be obtained for further advice in these situations as necessar

Question 4

Step 2 - Anatomical

Answer 4

in Step 2, pts do not have abnormal physiologic criteria present but may have obvious major injs that iindicate a moderate risk for clinical deterioration or probable need for definitive surgical management at a LTH

Question 5

Step 2 - Criteria

Answer 5

Adult and pediatric pts who meet any of the anatomical criteria should be transported directly to the nearest LTH

• Open or depressed skull fracture
• New paralysis or neurological deficits
• Major penetrating inj - (defined as all penetrating injuries to head, neck, torso and extremities to proximal)
• Facial injury w/ potential airway compromise
• Two or more proximal long-bone fractures
• Crushed, de-gloved, mangled or pulseless extremity
• Amputation proximal to wrist or ankle
• Chest wall instability or deformity (e.g flail chest)
• Major burns (defined as partial thickness burns >20%, full thickness >10% (2%> for pediatrics) facial or airway burns w/ or w/o inhalation inj, 3rd degree burns involving the eyes, neck, hands, feet or groin, high voltage electrical burns)
• Mechanically unstable pelvic fractures

Question 6

Step 2 - Major Penetrating Injury in Traumatic Arrest

Answer 6

Pts with a major penetrating injury in traumatic arrest with vital signs absent (VSA) are to be managed by the BCEHS Traumatic Arrest Protocol, and should immediately be transported directly to LTH (preferentially) or closest emergency department, if the time from loss of pulse and respiration to hospital is LESS THAN 15 minutes.

Otherwise, EPOS consultation should be obtained for decision to transport or discontinuation of resuscitation

Question 7

Step 2 - If Criteria Not Met

Answer 7

Similar to Step 1, regional destination guidelines may dictate that patients who meet anatomical criteria be initially transported to the nearest emergency department due to great distances or transport time to LTH. CliniCall or EPOS physician consultation can be obtained for further advice in these situations as necessary.

If these criteria have not been met, proceed to Step 3.

Question 8

Step 3 - Mechanism

Answer 8

The mechanism of injury (MOI) should be evaluated as some injuries may be occult or in pathophysiological evolution and are more severe.

The evaluation of the MOI will assist in determining if the patient should be transported to a Lead Trauma Hospital (LTH). This factor helps to reduce the possibility of under triage

Question 9

Step 3 - Criteria

Answer 9

1. Falls
   - Adults ≥ 6 metres (one story is equal to 3 metres)
   - Children ≥ 3 metres or two to three times the height of the child
2. High Risk Automobile Crash
   - Intrusion ≥ 0.3 metres occupant site; ≥ 0.5 metres any site, including the roof
   - Ejection (partial or complete) from automobile
   - Death in the same passenger compartment
   - Vehicle telemetry data consistent with high risk for injury (if available)
3. Auto vs. pedestrian/bicyclist thrown, run over or with significant (≥ 30 km/h) impact
4. Motorcycle crash ≥ 30 km/h

Question 10

Step 3 - If Criteria Not Met

Answer 10

CliniCall or EPOS physician consultation can be obtained for advice if required in the decision making process

If these criteria have not been met, proceed to Step 4

Question 11

Step 4 - Special Considerations

Answer 11

Pts may have underlying conditions that could put them at a greater risk for severe injury.

These criteria are indicators of the potential for significant injury or indicate that the patient may require other support services available at the LTH.

Pts who meet any of these criteria are recommended to be transported to a Lead Trauma Hospital (LTH) or to a hospital that is capable of a complete evaluation and timely treatment.

Question 12

Step 4 - Criteria

Answer 12

1. Age
   - Older adults
   
   • Risk of injury/death increases after age 55
   • SBP <110 may represent shock after age 65
     - Children
     - should be triaged preferentially to a pediatric-capable trauma center
2. Anticoagulation and bleeding disorders
3. Burns w/ trauma mechanism
4. Pregnancy => 20 weeks

If these criteria have not been met, transport the patient to the closest, most appropriate emergency department