1. EMS Professions1 Trauma Scoring Emergency Medical Technician - Basic

2. EMS Professions2 Trauma Score Uses u Triage –Level I Trauma Center? –Air Transport? u Assessment –Tracking condition changes

3. EMS Professions3 u Severity reporting to on-line medical control, receiving facility u Research u Outcomes assessment u Quality assurance Trauma Score Uses

4. EMS Professions4 Scoring Factors u Physiological Status –Airway –Breathing v Presence v Adequacy –Circulation/Perfusion v Presence v Adequacy –Disability

5. EMS Professions5 u Mechanism of Injury –Kinematics –Type, direction, amount of force Scoring Factors

6. EMS Professions6 Scoring Factors u Anatomical Site of Injury –Not accurate by self for pre-hospital use v Visible soft tissue/ orthopedic injury may distract from head, chest, abdominal trauma v Penetrating trauma depth/direction deceiving v Blunt trauma assessment difficult, especially abdomen

7. EMS Professions7 Scoring Factors u 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

8. EMS Professions8 Scoring Factors u Co-morbid Factors –Burns associated with other major trauma –Age 55 –Known cardiac, respiratory disease –Prolonged extrication/transport time

9. EMS Professions9 u Logistics –Extrication >20 minutes –Inaccessible scene –Long transport time Scoring Factors

10. EMS Professions10 u Kinematics--Motor Vehicle Collisions –Speed >20 MPH –Rearward displacement of front axle –Deformity of auto >20 inches –Passenger compartment intrusion v >15 inches - patient side v >20 inches - opposite side Scoring Factors

11. EMS Professions11 u Kinematics--Motor Vehicle Collisions –Rollover –Ejection from vehicle –Death/Serious injury of same car occupant Scoring Factors

12. EMS Professions12 Scoring Factors u Kinematics--Pedestrian vs Vehicle –Struck at >20 mph –Thrown > 15 feet –Child < 12 years old u Kinematics--Falls –>15 feet or >3x victim’s height

13. EMS Professions13 u If any of scoring factors present: –Patient will require Level I or II Trauma Center –If transport time >20 minutes consider calling helicopter Scoring Factors

14. EMS Professions14 Revised Trauma Score Commonly Used Prehospital Trauma Score

15. EMS Professions15 Revised Trauma Score u RTS component scores based on: –Glasgow scale –Respiratory rate –Systolic BP u Add component scores to determine RTS

16. EMS Professions16 Glasgow Coma Scale u Motor Response –1 = No response –2 = Abnormal extension –3 = Abnormal flexion –4 = Withdrawal –5 = Localizes pain –6 = Follows instructions

17. EMS Professions17 Glasgow Coma Scale u Verbal Response –1 = No response –2 = Incomprehensible sounds –3 = Inappropriate words –4 = Confused, disoriented –5 = Oriented

18. EMS Professions18 Glasgow Coma Scale u Eye Response –1 = No response –2 = To pain –3 = To verbal command –4 = Spontaneous

19. EMS Professions19 Glasgow Coma Scale Motor + Verbal + Eye = Glasgow Score What is lowest possible GCS Score?

20. EMS Professions20 Revised Trauma Score u Glasgow Coma Scale –0 = 1 - 3 GCS –1 = 4 - 5 GCS –2 = 6 - 8 GCS –3 = 9 - 12 GCS –4 = 13 - 15 GCS

21. EMS Professions21 Revised Trauma Score u Respiratory Rate –0 = 0 Respirations –1 = 1 to 5 Respirations –2 = 6 to 9 Respirations –3 = >29 Respirations –4 =10 to 29 Respirations

22. EMS Professions22 Revised Trauma Score u Systolic BP –0 = 0 –1 = 1 to 49 –2 = 50 to 75 –3 = 76 to 89 –4 = >89

23. EMS Professions23 Revised Trauma Score GCS score + Respiratory score + Systolic BP score = Revised Trauma Score