NREMT NCCR Content Covered

Broad Topic: Trauma

Subtopic: Trauma Triage

Available NCCR CME: 1 Hour

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LESSON OBJECTIVES

• Identify the triage criteria in the CDC’s Field Triage Decision Scheme
• State the four steps of the CDC’s Field Triage Decision Scheme
• Examine local protocols

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LESSON CONTENT

1. CDC Field Triage Decision Scheme
   1. Reference:
      1. ⁴Guidelines for Field Triage of Injured Patients, 2011
   2. Four specific steps to consider during triage
      1. Step 1—Assess vital signs and level of consciousness; they are good predictors of patient’s potential outcomes
         1. Glasgow Coma Scale (GCS)
         2. Systolic blood pressure
         3. Respiratory rate
      2. Step 2—Assess anatomy of injury
         1. Consider priority transport to a trauma facility if patient is found with:
            1. Penetrating injuries above the knee
            2. Unstable chest wall
            3. Proximal long bone fractures (two or more)
            4. Extremity that is crushed, degloved, mangled, or pulseless
            5. Amputation proximal to wrist or ankle
            6. Pelvic fractures
            7. Skull fractures (open or depressed)
            8. paralysis

3. Step 3—Assess mechanism of injury and evidence of high energy impact
   1. Consider priority transport to a trauma facility if the mechanism of injury (MOI) meets any of the following criteria, despite patient assessment findings in steps 1 and 2
      1. Falls
         1. Adults >20 feet
         2. Children >10 feet or >2x child’s height
      2. Auto crash
         1. Intrusion >12 inches where occupied or >18 inches on any side
         2. Partial or complete ejection from automobile
         3. Death in same automobile
         4. Vehicle telemetry data that indicates a high risk of injuries
      3. Pedestrian/bicyclist vs. automobile
         1. Thrown
         2. Run over
         3. Impact at speeds >20 mph
      4. Motorcycle crash >20 mph

4. Step 4—Assess special patient or system considerations
   1. Consider priority transport to a trauma facility if patient meets these special considerations:
      1. Older adults
         1. 55 years and older have increased chances of injury/death
         2. 65 years and older my present with shock if SBP is <110
         3. Mechanism is low impact (ground height falls)
      2. Children
         1. Consider transporting all children to pediatric trauma centers
      3. Anticoagulants and bleeding disorders
         1. Head injuries may present with rapid deterioration
      4. Burns
         1. No other trauma—triage to burn facility
         2. Other trauma findings—triage to trauma center
      5. Pregnancy >20 weeks
      6. Use provider judgement

2. Transport according to local protocol
   1. When in doubt transport to a trauma center