1. Trauma Triage Criteria Inservice 1998 Composed by: Laurie A. Romig, MD, FACEP Bayflite/Bayfront Medical Center

2. Development Adult and Pediatric Trauma Triage TAPs Trauma study by FSU Prospective pilot program of peds criteria Paper comparison of old and new adult criteria by state EMS medical director

3. Development (continued) Comparative prospective trial of adult criteria currently ongoing Pediatric and adult criteria established by rule in 64E in August 1998 Adult criteria optional at local level until November 1999

4. Common Features Color coded One RED criteria = Trauma Alert Two BLUE criteria = Trauma Alert Age or size now included Fewer mechanism of injury criteria Local criteria allowed EMS practitioner judgement allowed

5. Notes on Adult Criteria GCS < 12 = Trauma Alert independent of other criteria RED airway is defined as any airway support needed beyond oxygen Any BMR less than localizing pain is RED

6. Notes on Adult Criteria (cont.) > 15% BSA 2nd and 3rd degree burn is RED The only fractures included are longbone fractures: humerus, radius, ulna, femur, tibia, and fibula. Single long bone fracture is classified according to mechanism of injury Age > 55 is automatic BLUE criteria Ejection MOI excludes ejection from open motor vehicles

7. Detailed Adult Criteria GCS < 12 = RED AIRWAY  ACTIVE airway assistance required (i.e., more than supplemental O2 without airway adjunct)  Sustained respiratory rate > 30

8. Detailed Adult Criteria CIRCULATION  No radial pulse AND heart rate > 120 OR  BP < 90 systolic  Sustained heart rate > 120 with radial pulse and BP > 90 systolic

9. Detailed Adult Criteria BEST MOTOR RESPONSE  BMR < 4 OR  Paralysis, loss of sensation, suspicion of spinal cord injury  BMR = 5

10. Detailed Adult Criteria CUTANEOUS  Amputation proximal to wrist or ankle OR  > 15 % BSA 2nd and 3rd degree burns OR  Penetrating injury to head, neck, torso, excluding superficial wounds  Degloving injury or flap avulsion > 5 inches

11. Detailed Adult Criteria LONGBONE FRACTURE  Multiple longbone fracture sites  Single longbone fracture site due to MVC OR  Single longbone fracture site due to fall from > 10 feet

12. Detailed Adult Criteria AGE  Age > 55 MECHANISM OF INJURY  Ejection from vehicle (excludes open vehicles) OR  Driver with deformed steering wheel

13. Notes on Peds Criteria Applicable to age 15 or less Size component is based on Broslow color zone or weight Any airway maintenance beyond supplemental O2 and one-time need for suctioning = RED Any altered mental status other than amnesia = RED criteria Paralysis, loss of sensation, or suspicion of spinal cord injury = RED criteria under “Consciousness” category

14. Notes on Peds Criteria (cont.) Any reliable hx of LOC = BLUE Fracture criteria are also based on longbones (same as adults). Open long bone or multiple longbone fx/dislocations = RED > 10 % BSA 2nd and 3rd degree burn = RED

15. Detailed Peds Criteria SIZE  Weight < 10 Kg (< 22 lbs..) or RED or PURPLE Broslow Tape Zone AIRWAY  ACTIVE airway assistance required (i.e., more than supplemental O2/one-time suctioning without airway adjunct)

16. Detailed Peds Criteria CONSCIOUSNESS  Patient not awake and appropriate OR  Paralysis, loss of sensation, or suspected spinal cord injury  Amnesia OR  Reliable history of loss of consciousness

17. Detailed Peds Criteria CIRCULATION  No palpable pulses OR  Weak carotid or femoral pulse OR  Systolic BP < 50  Good carotid or femoral pulse with absent distal pulses OR  Systolic BP 50-90

18. Detailed Peds Criteria LONGBONE FRACTURE  Any open longbone fracture OR  Multiple closed longbone fracture sites or dislocations  Single closed long bone fracture site

19. Detailed Peds Criteria CUTANEOUS  Degloving injury, major flap avulsion OR  Amputation proximal to wrist or ankle OR  > 10% BSA 2nd and 3rd degree burns OR  Penetrating injury to head, neck or torso

20. Practice Case #1 68 yo female pedestrian struck GCS 14, BMR 5 Patent airway HR 100, BP 120/94, RR 20 Abrasions Unstable pelvis  BLUE  POSITIVE TRAUMA ALERT

21. Practice Case #2 21 yo male Stab wound to left chest Airway patent GCS 15 BS  on left BP 90/P, HR 130  RED POSITIVE TRAUMA ALERT

22. Practice Case #3 4 year old near- drowning in pool No signs of trauma Intubated Normal skin signs Normal brachial pulse Responsive to deep pain Drowning is not considered trauma unless injury accompanies it!

23. Practice Case #4 6 yo female fell 10 ft. from tree 22 kg weight amnestic for event, o/w alert airway patent obvious closed forearm fx nl vital signs  BLUE POSITIVE TRAUMA ALERT

24. Practice Case # 5 6 month old male (purple) child abuse multiple cigarette burns & contusions abdomen rigid strong palpable carotid pulse only does not cry with exam  BLUE  RED POSITIVE TRAUMA ALERT

25. Implementation