The Expert Panel for field triage of trauma patients updated the 2006 guidance in 2011/2012.

NOTE: The differences from the 2006 guidance are listed on Box 2 on page 8.



(1) vital signs and level of consciousness

(2) anatomy of injury

(3) mechanism of injury and evidence of high-energy impact

(4) special patient or system considerations


Vital signs and level of consciousness (VSLOC):

(1) Glasgow coma score <= 13 (in 2006 was < 14)

(2) systolic blood pressure < 90 mm Hg (< 110 mm Hg if > 65 years old)

(3) respiratory rate > 29 breaths per minute

(4) respiratory rate < 10 breaths per minute if >= 1 year old

(5) respiratory rate < 20 breaths per minute if infant < 1 year old

(6) need for ventilatory support


Anatomy of injury:

(1) penetrating injury to head, neck or torso

(2) penetrating injuries to extremities proximal to elbow or knee

(3) chest wall instability or deformity (flail chest, etc)

(4) two or more proximal long bone fractures

(5) crushed, degloved, mangled or pulseless extremity

(6) amputation proximal to wrist or ankle

(7) pelvic fracture

(8) open or depressed skull fracture

(9) paralysis


Mechanism of injury and high-energy impact:

(1) adult fall > 20 feet (more than 2 stories)

(2) child fall > 10 feet or fall more than 2 times height of the child

(3) intrusion > 12 inches on occupant site, including roof

(4) any intrusion > 18 inches

(5) ejection from automobile (partial or complete)

(6) death in same passenger compartment

(7) vehicle telemetry data consistent with a high risk of injury

(8) pedestrian hit by vehicle thrown, run over or impact > 20 mph

(9) bicyclist hit by vehicle, thrown, run over or impact > 20 mph

(10) motorcycle crash > 20 mph


Special considerations:

(1) adult > 55 years of age, including low impact mechanism

(2) anticoagulation and bleeding disorder, especially with head injury

(3) burns

(4) pregnancy > 20 weeks

(5) EMS provider judgment


Positive Finding


VSLOC or anatomy of injury

to highest level of care available

mechanism of injury or high-energy impact

to trauma center (need not be highest available)

special consideration

to trauma center or hospital with adequate resources; consider consult with medical control

burns without trauma

burn center

pediatric patient

pediatric capable trauma center

none of the above

according to EMS protocol

if in doubt

trauma center


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