Trauma Triage Criteria Inservice 1998

1. Trauma Triage Criteria Inservice1998 Composed by: Laurie A. Romig, MD, FACEP Bayflite/Bayfront Medical Center

2. Development • Adult and Pediatric Trauma Triage TAPs • Trauma study by FSU • Prospective pilot program of peds criteria • Paper comparison of old and new adult criteria by state EMS medical director

3. Development (continued) • Comparative prospective trial of adult criteria currently ongoing • Pediatric and adult criteria established by rule in 64E in August 1998 • Adult criteria optional at local level until November 1999

4. Common Features • Color coded • One RED criteria = Trauma Alert • Two BLUE criteria = Trauma Alert • Age or size now included • Fewer mechanism of injury criteria • Local criteria allowed • EMS practitioner judgement allowed

5. Notes on Adult Criteria • GCS < 12 = Trauma Alert independent of other criteria • RED airway is defined as any airway support needed beyond oxygen • Any BMR less than localizing pain is RED

6. Notes on Adult Criteria (cont.) • >15% BSA 2nd and 3rd degree burn is RED • The only fractures included are longbone fractures: humerus, radius, ulna, femur, tibia, and fibula. • Single long bone fracture is classified according to mechanism of injury • Age > 55 is automatic BLUE criteria • Ejection MOI excludes ejection from open motor vehicles

7. Detailed Adult Criteria GCS < 12 = RED AIRWAY  ACTIVE airway assistance required (i.e., more than supplemental O2 without airway adjunct)  Sustained respiratory rate > 30

8. Detailed Adult Criteria CIRCULATION No radial pulse AND heart rate > 120 OR BP < 90 systolic Sustained heart rate > 120 with radial pulse and BP > 90 systolic

9. Detailed Adult Criteria BEST MOTOR RESPONSE BMR < 4 OR Paralysis, loss of sensation, suspicion of spinal cord injury BMR = 5

10. Detailed Adult Criteria CUTANEOUS Amputation proximal to wrist or ankle OR > 15 % BSA 2nd and 3rd degree burns OR Penetrating injury to head, neck, torso, excluding superficial wounds Degloving injury or flap avulsion > 5 inches

11. Detailed Adult Criteria LONGBONE FRACTURE Multiple longbone fracture sites Single longbone fracture site due to MVC OR Single longbone fracture site due to fall from > 10 feet

12. Detailed Adult Criteria AGE Age > 55 MECHANISM OF INJURY Ejection from vehicle (excludes open vehicles) OR Driver with deformed steering wheel

13. Notes on Peds Criteria • Applicable to age 15 or less • Size component is based on Broslow color zone or weight • Any airway maintenance beyond supplemental O2 and one-time need for suctioning = RED • Any altered mental status other than amnesia = REDcriteria • Paralysis, loss of sensation, or suspicion of spinal cord injury = RED criteria under “Consciousness” category

14. Notes on Peds Criteria (cont.) • Any reliable hx of LOC = BLUE • Fracture criteria are also based on longbones (same as adults). • Open long bone or multiple longbone fx/dislocations = RED • >10 % BSA 2nd and 3rd degree burn = RED

15. Detailed Peds Criteria SIZE Weight < 10 Kg (< 22 lbs..) or REDor PURPLEBroslow Tape Zone AIRWAY ACTIVE airway assistance required (i.e., more than supplemental O2/one-time suctioning without airway adjunct)

16. Detailed Peds Criteria CONSCIOUSNESS Patient not awake and appropriate OR Paralysis, loss of sensation, or suspected spinal cord injury Amnesia OR Reliable history of loss of consciousness

17. Detailed Peds Criteria CIRCULATION No palpable pulses OR Weak carotid or femoral pulse OR Systolic BP < 50 Good carotid or femoral pulse with absent distal pulses OR Systolic BP 50-90

18. Detailed Peds Criteria LONGBONE FRACTURE Any open longbone fracture OR Multiple closed longbone fracture sites or dislocations Single closed long bone fracture site

19. Detailed Peds Criteria CUTANEOUS Degloving injury, major flap avulsion OR Amputation proximal to wrist or ankle OR > 10% BSA 2nd and 3rd degree burns OR Penetrating injury to head, neck or torso

20. 68 yo female pedestrian struck GCS 14, BMR 5 Patent airway HR 100, BP 120/94, RR 20 Abrasions Unstable pelvis BLUE BLUE  Practice Case #1 POSITIVE TRAUMA ALERT

21. 21 yo male Stab wound to left chest Airway patent GCS 15 BS  on left BP 90/P, HR 130 RED RED Practice Case #2 POSITIVE TRAUMA ALERT

22. 4 year old near- drowning in pool No signs of trauma Intubated Normal skin signs Normal brachial pulse Responsive to deep pain Practice Case #3 Drowning is not considered trauma unless injury accompanies it!

23. 6 yo female fell 10 ft. from tree 22 kg weight amnestic for event, o/w alert airway patent obvious closed forearm fx nl vital signs BLUE BLUE Practice Case #4 POSITIVE TRAUMA ALERT

24. 6 month old male (purple) child abuse multiple cigarette burns & contusions abdomen rigid strong palpable carotid pulse only does not cry with exam BLUE BLUE RED Practice Case # 5 POSITIVE TRAUMA ALERT

25. Implementation