EMS Policy Manual - Contra Costa Health Services

Contra Costa
Emergency Medical Services
EMERGENCY RE-TRIAGE AND TRANSFERS TO
TRAUMA CENTERS
POLICY #: 14
PAGE: 1 of 4
EFFECTIVE: 1/13
REVIEWED: 12/12
I. PURPOSE
To outline the criteria and process for emergency re-triage and for transfer of patients needing trauma
care from non-trauma facilities to appropriate trauma centers.
II. POLICY
Under field trauma triage protocols, most critical trauma patients will be triaged directly to a Trauma
Center from the field. Trauma patients who present at other facilities via EMS or other arrival mode,
when medically appropriate, should be considered for re-triage or transfer to trauma centers for
definitive care.
III. DEFINITIONS
A. Emergency Trauma Re-triage: The movement of patients meeting specific high-acuity criteria
to trauma center for trauma care. Timeliness of evaluation and intervention at the trauma center
is critical.
B. Trauma Transfer: The movement of other patients with traumatic injuries to the trauma center
(those not meeting Emergency Trauma Re-Triage criteria) whose needs may be addressed in a
prompt fashion but are less likely to require immediate intervention.
IV. EMERGENCY TRAUMA RE-TRIAGE PATIENT SELECTION
A. Adult Patients (Age 15 and Over) appropriate for Emergency Trauma Re-Triage to the trauma
center** include:
1. Patients with abnormal blood pressure/perfusion as evidenced by:
a. Systolic blood pressure under 90
b. Need for high-volume fluid resuscitation (> 2 L NS) or immediate blood replacement
2. Patients with significant neurological findings or injuries, including
a. GCS less than 9 or deteriorating by 2 or more during observation
b. Blown pupil
c. Obvious open skull fracture
3. Patients meeting anatomic criteria:
a. Penetrating injury to head, neck, chest, or abdomen
b. Extremity injury with ischemia evident or loss of pulses
4. Patients, who in the judgment of the evaluating emergency physician, are anticipated to
have a high likelihood for emergent life- or limb-saving surgery or other intervention within
two (2) hours.
** Note: John Muir Health - Walnut Creek, Alameda County Medical Center (Highland), and Eden
Medical Center all utilize these re-triage criteria. Criteria may vary at other centers.