National Expert Panel Recommendations for Field Triage of an Injured Patient

 

The process consists of 4 assessment steps:

(1) physiologic evaluation

(2) anatomic injuries

(3) mechanism of injury

(4) special considerations

 

Indications to transfer the patient to a trauma center - one or more of the following:

(1) Glasgow coma score < 14

(2) systolic blood pressure < 90 mm Hg

(3) respiratory rate < 10 breaths per minute if >= 1 year old or < 20 breaths per minute if < 1 year old

(4) respiratory rate > 29 breaths per minute

(5) penetrating trauma to head, neck, torso, upper extremity proximal to the elbow and/or lower extremity proximal to the knee

(6) flail chest

(7) 2 or more proximal long bone fractures

(8) crush injury

(9) degloving injury

(10) mangled extremity

(11) amputation proximal to the wrist and/or ankle

(12) pelvic fracture

(13) open or depressed skull fracture

(14) paralysis

(15) fall > 20 feet for an adult

(16) fall > 10 feet or > 2 times height for a child

(17) high risk automotive crash with intrusion into the interior compartment > 12 inches on occupant side or > 18 inches anywhere

(18) ejection from a vehicle

(19) automative crash with a death in the same passenger subcompartment

(20) crash with vehicle telemetry data indicating high risk of injury

(21) pedestrian hit by automobile and run over, thrown a distiance or hit at > 20 miles per hour

(22) bicyclist hit by automobile and run over, thrown a distance or hit at > 20 miles per hour

(23) motorcycle crash > 20 miles per hour

(24) age > 55 years

(25) age < 15 years of age

(26) anticoagulation or bleeding disorder

(27) severe burn

(28) time sensitive extremity injury (open fracture, fracture with neurovascular compromise, etc)

(29) end-stage renal disease requiring dialysis

(30) pregnancy > 20 weeks

(31) EMS provider judgment

 

Recommendations:

(1) A burn patients without other trauma should be triaged to a burn center.

(2) A pediatric patient should be triaged to a pediatric trauma center if available.

(3) A patient not triaged to a trauma center should be routed to the most appropriate facility.