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.

2. Anatomical Injuries

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

3. 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 (2^nd or 3^rd 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 (2^nd or 3^rd 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.