EMS Policy Manual - Contra Costa Health Services

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Contra Costa Emergency Medical Services TRIAGE OF TRAUMA PATIENTS POLICY #: 13 PAGE: 1 of 5 EFFECTIVE: 1/13 REVIEWED: 12/12 I. PURPOSE Trauma triage directs trauma patients to appropriate medical facilities for definitive care. The goal of triage is to identify critically injured patients who need rapid surgical intervention or the specialized services of the trauma center. II. DEFINITIONS Base Hospital: John Muir Medical Center – Walnut Creek Campus is the designated base hospital for Contra Costa County. Adult Patients: Adult trauma patients are 15 years of age and older. Pediatric Patients: Pediatric trauma patients are ages 0 up to 14 years and 364 days. Adult Trauma Center: The most appropriate trauma center for adults is John Muir Medical Center – Walnut Creek Campus. Pediatric Trauma Center: The most appropriate trauma center for pediatric patients is Children’s Hospital, Oakland if transport can be made in less than 30 minutes. High-Risk Criteria: Symptoms and mechanisms that correlate with a high risk of critical trauma injuries and merit direct transport to a trauma center. Early Notification Call: For patients meeting high-risk criteria (direct transport to the trauma center) a brief notification to allow the trauma center to prepare resources pending the patient’s arrival. The call should be made as early as possible, preferably before leaving the scene. Call-In Criteria: For patients who do meet high-risk criteria, but have trauma mechanisms that could potentially cause severe trauma. These patients require a destination determination call to the base hospital. Destination Determination: For patients meeting call-in criteria, the base hospital physician will determine which patients warrant trauma center destination based on the report of the field personnel. 5-minute Update: Notification from the field to the trauma center that the patient will be arriving in five minutes. This call initiates hospital activation of a trauma team. Patients with Unmanageable Airway: Patients whose airways are unable to be adequately maintained with BLS or ALS maneuvers. Adult patients are candidates for immediate redirection to the trauma center following airway stabilization at a receiving facility other than the trauma center.
Contra Costa Emergency Medical Services III. TRAUMA TRIAGE ALGORITHM High-Risk Criteria Unmanageable airway Trauma arrest (not meeting field determination) NO PHYSIOLOGIC CRITERIA BP 20 minutes - Fatalities in the same vehicle - Ejection from vehicle Unrestrained MVC with: - Head-on mechanism > 40 mph - Extrication required Fall 15 feet or greater Auto vs. pedestrian/bicyclist thrown, run over, or with significant (>20 mph) impact NO COMBINED CRITERIA Motorcycle crash with: - Abdominal or chest tenderness - Observed loss of consciousness Unrestrained motor vehicle crash with: - Abdominal tenderness NO MEETS CALL-IN CRITERIA? YES *Exceptions outlined in Policy 13 VI. B. 1. YES YES YES POLICY #: 13 **In the absence of significant symptoms or physical findings despite mechanism, call for destination decision instead of early notification. YES YES PAGE: 2 of 5 Closest Facility* Early notification, Trauma Center Transport Early notification, Trauma Center Transport Early notification, Trauma Center Transport Early notification, Trauma Center Transport Call for Destination Decision For possible helicopter transports only: Trauma patients who do not meet high-risk criteria but by evaluation of mechanism and physical exam findings appear to have potential significant injuries merit early notification call and rapid Trauma Center transport.
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Page 3 and 4: EMS Policies # 1 - EMT-1 Certificat
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EMS Policy Manual - Contra Costa Health Services

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