2011 Recommendations of the National Expert Panel for Field Triage of an Injured Patient

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

 

Assessments:

(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	Triage
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