Emergency Medical Technician - Basic 5/6/2019 Trauma Scoring Emergency Medical Technician - Basic EMS Professions Temple College EMS Professions

Trauma Score Uses Triage Assessment Level I Trauma Center? Air Transport? Assessment Tracking condition changes EMS Professions

Trauma Score Uses Outcomes assessment Severity reporting to on-line medical control, receiving facility Research Outcomes assessment Quality assurance EMS Professions

Scoring Factors Physiological Status Circulation/Perfusion Airway Presence Adequacy Disability Physiological Status Airway Breathing Presence Adequacy EMS Professions

Scoring Factors Mechanism of Injury Kinematics Type, direction, amount of force EMS Professions

Scoring Factors Anatomical Site of Injury Not accurate by self for pre-hospital use Visible soft tissue/ orthopedic injury may distract from head, chest, abdominal trauma Penetrating trauma depth/direction deceiving Blunt trauma assessment difficult, especially abdomen EMS Professions

Scoring Factors Anatomical Site of Injury Penetrating trauma Chest, abdomen, head, neck, groin > 2 long bone fractures Burns >15% BSA, face, airway Flail chest Scalping injury Paralysis Amputation proximal to wrist/ankle EMS Professions

Scoring Factors Co-morbid Factors Burns associated with other major trauma Age < 5 or > 55 Known cardiac, respiratory disease Prolonged extrication/transport time EMS Professions

Scoring Factors Logistics Extrication >20 minutes Inaccessible scene Long transport time EMS Professions

Scoring Factors Kinematics--Motor Vehicle Collisions Speed >20 MPH Rearward displacement of front axle Deformity of auto >20 inches Passenger compartment intrusion >15 inches - patient side >20 inches - opposite side EMS Professions

Scoring Factors Kinematics--Motor Vehicle Collisions Rollover Ejection from vehicle Death/Serious injury of same car occupant EMS Professions

Scoring Factors Kinematics--Pedestrian vs Vehicle Kinematics--Falls Struck at >20 mph Thrown > 15 feet Child < 12 years old Kinematics--Falls >15 feet or >3x victim’s height EMS Professions

Scoring Factors If any of scoring factors present: Patient will require Level I or II Trauma Center If transport time >20 minutes consider calling helicopter EMS Professions

Commonly Used Prehospital Trauma Score Revised Trauma Score Commonly Used Prehospital Trauma Score EMS Professions

Revised Trauma Score RTS component scores based on: Glasgow scale Respiratory rate Systolic BP Add component scores to determine RTS EMS Professions

Glasgow Coma Scale Motor Response 1 = No response 2 = Abnormal extension 3 = Abnormal flexion 4 = Withdrawal 5 = Localizes pain 6 = Follows instructions EMS Professions

Glasgow Coma Scale Verbal Response 1 = No response 2 = Incomprehensible sounds 3 = Inappropriate words 4 = Confused, disoriented 5 = Oriented EMS Professions

Glasgow Coma Scale Eye Response 1 = No response 2 = To pain 3 = To verbal command 4 = Spontaneous EMS Professions

Glasgow Coma Scale Motor + Verbal + Eye = Glasgow Score What is lowest possible GCS Score? EMS Professions

Revised Trauma Score Glasgow Coma Scale 0 = 1 - 3 GCS 1 = 4 - 5 GCS EMS Professions

Revised Trauma Score Respiratory Rate 0 = 0 Respirations 1 = 1 to 5 Respirations 2 = 6 to 9 Respirations 3 = >29 Respirations 4 =10 to 29 Respirations EMS Professions

Revised Trauma Score Systolic BP 0 = 0 1 = 1 to 49 2 = 50 to 75 4 = >89 EMS Professions

Revised Trauma Score GCS score + Respiratory score + Systolic BP score = Revised Trauma Score EMS Professions