Lake Superior RTAC Trauma Triage Plan - October, 2004                                                                     

 

Definition of Major Trauma

 

Major Trauma includes the following categories:

  1. Physiologic Status

l        Patients with multi-system blunt or penetrating trauma and unstable vital signs.

  1. Anatomical Injuries

l        Patients with known or suspected anatomical injuries and stable or normal vital signs.

  1. Mechanism of Injury

l        Patients who are involved in a “high energy” event with a risk for severe injury despite stable or normal vital signs.

 

Once these patients are identified, an appropriate systems response should be activated.  Triage occurs at both the pre-hospital and hospital level.

 

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Activate Local Trauma Plan

 

Major Trauma – Adult

 

Major Trauma – Pediatric

l   Inadequate Airway, grunting, or stridor

·    Multi-system Blunt or Penetrating Trauma
 with Unstable Vital Signs (Systolic BP<90, HR>120,

 Resp < 10 or > 30, GCS < 14, RTS < 11)

l   Penetrating injury of head, neck, torso, groin

l   Burns 15% TBSA (2nd or 3rd degree) or involving face,

 airway, hands, feet, or genitalia   

l   Amputation proximal to wrist or ankle

l   Paralysis or other signs of spinal cord injury

l   Flail chest

l   Open or suspected depressed skull fracture

l   Unstable pelvis or suspected pelvis fracture

l   Two or more proximal long bone fractures suspected

l   Distended, rigid abdomen with signs of shock



 

 

·      Inadequate Airway, grunting, or stridor

·      Multi-system Blunt or Penetrating Trauma  with

Unstable Vital Signs                                                                      
(Systolic BP – Neonate <60
                        Infant (<2 yrs) <65
                        Child (2-5 yrs) <70

                            Child (6-12 yrs) <80

l     Respirations (all ages) <10 or >60

l     GCS <14

l     PTS <9

l   Penetrating injury of head, neck, torso, groin

l   Burns 15% TBSA (2nd or 3rd degree) or involving 

 face, airway, hands, feet, or genatalia

l   Amputation proximal to wrist or ankle

l   Paralysis or other sign s of spinal cord injury

l   Flail chest

l   Open or suspected depressed skull fracture

l   Unstable pelvis or suspected pelvis fracture

l   Two or more proximal long bone fractures 

     suspected

l   Distended, rigid abdomen with signs of shock

 

 

 

 

 

 

Consider Trauma Plan Activation

High Risk Factors for Major Trauma

l  Ejection from vehicle

l  Vehicle rollover

l  Bent steering wheel (driver)

l  Major auto deformity (damage into passenger area)

l  Auto-Pedestrian or Auto-Bicycle impact

l  High speed vehicle crash (>40MPH adult and >20MPH child)

l  Motorcycle or ATV crash

l  Fatality in same vehicle

l  Prolonged extrication (>20 minutes)

l  Fall >20 feet adult and >10 feet child

l  Pregnancy

l  Age <5 or >55

l  Significant underlying medical conditions (lung, heart, diabetes, bleeding disorder, anticoagulants, immunosuppressed)

l  Significant assault

l   

Lake Superior RTAC Trauma Triage Plan October, 2004                                                                  

 

Prehospital Major Trauma Triage & Transport

 

 Air Medical & ALS Intercept Guidelines

If patient meets major trauma criteria, dispatch helicopter and/or ground ALS.

 

Major Trauma Patient                                 No                                      Manage per established protocols

                                                                                                      Transport to nearest appropriate facility

       

             Yes

 


  

   Adequate Airway                                         No                                 Manage per established protocols

                                                                                                                 ALS Intercept

                                                                                                         Transport to nearest appropriate facility

 

             Yes                                                                                    

 

 


Is level I or II Trauma                                  No                                   Manage per established protocols    Center >30 minutes away?                                                                                             Transport to Level I or II Trauma Center

   (scene + transport time)

  

                                                                                                                                  

         Yes

 

 


   Dispatch Helicopter and/or ALS Intercept

   (depending on time = scene + transport time)

 

 


Can Helicopter Fly?                                   No                                   Consider ALS Intercept 

                                                                                                      Transport to nearest appropriate facility

 


         

          Yes

 

 


   Helicopter Intercept or Meet at Closest Facility

   Transport to Level I or II Trauma Center      

 

Air ALS Transport is indicated, if time and weather permits, when critical care is needed during transport, the distance is long, prolonged scene time (eg. prolonged extrication, multiple trauma patients, difficult topography), and it will reduce the time to a crucial intervention while en route or at tertiary care.

 

Critical Care Ground Intercept may be requested by BLS / ALS when air transport is not available and/or critical care is needed during transport.

 

Ground ALS Intercept is indicated when time is crucial to patient outcome and either air transport is not available or would not result in time savings.  This option should be encouraged if the needed level of care cannot be maintained by the provider bringing the patient to an intercept.

 

Ground Transport is indicated when BLS / ALS meets the needs of the patient, other transport is not available, air transport would not result in time savings, or time is not crucial to patient outcome.

 

________________________________  accepts LSRTAC regional major trauma definition and transport guidelines.

NAME OF AMBULANCE SERVICE

 

___________________________________________   ________________  endorses these guidelines and major trauma definition.

EMS  MEDICAL  DIRECTOR                                           DATE


Lake Superior RTAC Trauma Triage Plan                                                       

 

 

Prehospital Triage & Transport Guidelines

 

Transportation time from injury to definitive care will meet the “Golden Hour”.  This is the goal of the Lake Superior RTAC.

For the patient that sustains major trauma, the following guidelines will be observed:

 

Scene Safety

 

All responders will assess scene safety and follow universal precautions.  If the scene is determined to be unsafe, do not put yourself or others in danger of injury or exposure.  The Incident Commander will contact law enforcement or other agencies to further secure the scene and determine safety precautions to be used in order to proceed.

 

Major Trauma Definition

 

Adult and Pediatric Major Trauma Definition and Transport Algorithm may be found on the following two pages.  Patients meeting the criteria for major trauma should be transported to the nearest Level I or Level II Trauma Center in the most expeditious manner.  Any recognized emergency services agency may request ALS ground and/or helicopter.

 

Communications

 

Dispatch should consider activating the helicopter for incidents involving “High Risk Factors for Major Trauma” (see Definition of Major Trauma document). 

 

Trauma Alert

 

The receiving facility needs to be notified to activate their “Trauma Alert” system.  The Incident Commander is responsible for early notification of the receiving facility for patients meeting the definition of major trauma.

 

Transport

 

It is the goal of Lake Superior RTAC that transport time should be less than 30 minutes to the nearest appropriate facility.

 

The decision for transport destination should be made by the first recognized emergency services agency person to arrive and assess the patient.  This may require a BLS unit to request an ALS ground unit for intercept or to request a helicopter directly to the scene.  For delayed extrication, a helicopter should be requested.

 

In a trauma situation, transport destination may be made without immediate Medical Control contact.  Medical Control may be consulted or notified of the situation if necessary.

 

Providers should remember that while trauma centers provide definitive care and life-saving surgery, local hospitals can provide life-saving interventions before transfer if needed.  Uncontrollable airway and CPR patients should be transported to the nearest hospital.

 

Depending on location, bad weather, mechanical failure, or communication breakdown, patients should be transported to the nearest appropriate hospital for stabilization.  This may also include helicopter intercept, critical care ground transport, or ALS ground intercept.