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CRITERIA FOR TRIAGE TO TRAUMA ROOM

These pages are excerpted from the Trauma Resident Handbook, Rhode Island Hospital Department of Surgery, Division of Trauma - updated 2001. The policies herein are intended to serve as guidelines only. Individual circumstances need to be considered as there may be times when it is appropriate or desirable to deviate from these guidelines. These educational guidelines will be reviewed and updated routinely.

Physiological Alterations
LEVEL I

  • Pediatric Trauma Score < 8
  • Known LOC > 5 minutes
  • Core temperature <28° C or <82° F
  • Abnormal vital signs:

     Age

    Systolic BP
    (mm Hg)

    Pulse
    (bpm)

    Respirations (breaths/min)

     0-2

    < 70

    < 80 or > 180

    < 15 or > 40

    3-5

    < 80

    < 60 or > 170

    < 10 or > 30

    > 6

    < 90

    < 60 or > 160

    < 10 or > 25

Physiological Distress
LEVEL I

  • Shock following injury with:
    • Delayed capillary refill
    • Pale, cool, mottled skin
    • Weak, rapid pulse
    • Decreased LOC
    • Rapid, shallow respirations
  • Respiratory distress following injury with:
    • Increased or decreased respiratory rate
    • Cyanosis
    • Grunting
    • Retraction, flaring
    • Airway obstruction

Mechanism of Injury (assumes physiological stability)
LEVEL I

  • Burns associated with suspected inhalation injury
  • Burns (large) involving face, hands, feet or genitals
  • Burns >10% BSA
  • Electrical injuries involving high tension wire or lightning
  • Strangulations/hangings
  • GSW/SGW of head, neck, torso
  • Penetrating injuries of extremities with neurovascular deficit
  • Stab wounds of head, neck, torso
  • Steering wheel/windshield deformity
  • Fatality within the vehicle
  • Ejection from vehicle
  • Pregnant patients when history is suggestive of major trauma
  • Intoxicated patients when history is suggestive of major trauma
  • Pedestrian hit by vehicle moving >20 mph
  • Unrestrained occupants of motor vehicle involved in crash at >20 mph
  • Restrained occupants of motor vehicle involved in crash at >40 mph
  • Thrown from vehicle or into the air >5 feet
  • Falls >8 feet


LEVEL II

  • Intrusion of space >1 foot
  • Extrication time >20 minutes
  • Rollovers
  • Falls <8 feet
  • Penetrating extremity injury without neurovascular deficits

Anatomical Alterations
LEVEL I

  • C-spine injury
  • Uncontrolled traumatic hemorrhage
  • Severe maxillofacial injuries
  • Unstable chest injuries
  • Major pelvic injuries (pelvic instability)
  • Blunt abdominal trauma with hypotension, rigidity or significant tenderness
  • Penetrating wound or crush injury to the head, neck, chest, abdomen, pelvis or groin
  • Neurological injuries producing altered mental status, posturing, seizures, lateralizing signs of paralysis
  • Two or more proximal long bone fractures
  • Tracheal and laryngeal injuries


LEVEL II

  • Blunt trauma with complaints relative to abdomen or thorax
  • Single long bone fracture in association with other injury
  • Open fractures

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