TRAUMA FIELD TRIAGE CRITERIA

A licensee providing emergency medical care to a patient at the scene of an injury shall use the following procedures to identify and care for patients with traumas:

1.  Step 1 – Measure vital signs and level of consciousness. If the patient’s:

A.  Glasgow Coma Scale is 13 or less;

B.  Systolic blood pressure is less than 90 mmHg; or

C.  Respiratory rate is less than 10 or greater than 29 breaths per minute (less than 20 in infant aged less than 1 year), or is in need of ventilatory support

the adult patient MUST be transported to a Level 1 or 2 center for the treatment of trauma in accordance with the catchment area designated. The pediatric patient MUST be transported to a pediatric center for the treatment of trauma.

2.  Step 2 – Assess anatomy of injury. If the patient has:

A.  Penetrating injuries to head, neck, torso, or extremities proximal to elbow or knee;

B.  Chest wall instability or deformity (e.g. flail chest);

C.  Two or more proximal long-bone fractures;

E.  Amputation proximal to wrist or ankle;

F.  Pelvis fractures;

G.  Open or depressed skull fractures; or

H.  Paralysis;

the adult patient MUST be transported to a Level 1 or 2 center for the treatment of trauma in accordance with the catchment area designated. The pediatric patient MUST be transported to a pediatric center for the treatment of trauma.

3.  Step 3 – Assess mechanism of injury and evidence of high-energy impact, which may include:

A.  Falls

1)  Adults: greater than 20 feet (one story is equal to 10 feet)

2)  Children: greater than 10 feet or two times the height of the child

B.  High-risk auto crash

1)  Motor vehicle was traveling at a speed of at least 40 miles per hour immediately before the collision occurred;

2)  Intrusion, including roof: greater than 12 inches occupant site; greater than 18 inches any site;

3)  Ejection (partial or complete) from automobile;

4)  Motor vehicle rolled over with unrestrained occupant(s);

5)  Death in same passenger compartment

C.  Motorcycle crash greater than 20 mph

D.  Auto vs pedestrian/bicyclist thrown, run over, or with significant (greater than 20 mph) impact

the patient MUST be transported to a Level 1, 2, or 3 center for the treatment of trauma in accordance with the catchment area designated. For patients who are injured outside a 50-mile radius from a trauma center, the licensee providing emergency medical care shall call and consider transport to the nearest receiving facility.

4.  Step 4 – Assess special patient or system considerations, such as:

A.  Older adults

1)  Risk of injury/death increases after age 55 years

2)  SBP less than 110 mmHg might represent shock after age 65 years

3)  Low impact mechanisms (e.g. ground level falls) might result in severe injury

B.  Children should be triaged preferentially to a trauma center.

C.  Anticoagulants and bleeding disorders: Patients with head injury are at high risk for rapid deterioration.

D.  Burns

1)  Without other trauma mechanisms: transport in accordance with the Burns protocol

2)  With trauma mechanism: transport to UMC Trauma/Burn Center

E.  Pregnancy greater than 20 weeks

F.  EMS provider judgment

The person licensed to provide emergency medical care at the scene of an injury shall transport a patient to a designated center for the treatment of trauma based on the following guidelines:

St. Rose Dominican Hospital - Siena Campus (Level 3 Trauma Center) Catchment Area

All trauma calls that meet Step 3 or in the provider’s judgment meet Step 4 of the Trauma Field Triage Criteria Protocol and occur within the City of Henderson or the geographical area bordered by Interstate 15 to the west and Sunset road to the north, and the county line to the east, are to be transported to St. Rose Dominican Hospital – Siena Campus and the medical directions for the treatment of the patient must originate at that center;

Sunrise Hospital & Medical Center (Level 2 Trauma Center) Catchment Area

All adult trauma calls and pediatric Step 3 trauma calls that meet the Trauma Field Triage Criteria Protocol and occur within the geographical area bordered by Paradise Road to the west, Sahara Avenue to the north, Sunset Road to the south, and the county line to the east, are to be transported to Sunrise Hospital & Medical Center and the medical directions for the treatment of the patient must originate at that center;;

In addition, adult trauma calls that meet Step 1 or 2 of the Trauma Field Triage Criteria Protocol and occur within the St. Rose Dominican Hospital – Siena Campus Catchment Area, City of Henderson, or the geographical area bordered by Paradise Road to the west continuing along that portion where it becomes Maryland Parkway, Sunset Road to the north, and the county line to the east, are to be transported to Sunrise Hospital & Medical Center and the medical directions for the treatment of the patient must originate at that center.

University Medical Center (Level 1 Trauma Center and Pediatric Level 2 Trauma Center) Catchment Area

All trauma calls that meet the Trauma Field Triage Criteria and occur within any other area of Clark County are to be transported to University Medical Center/Trauma and the medical directions for the treatment of the patient must originate at that center.

All pediatric Step 1 and Step 2 trauma calls that occur within Clark County are to be transported to University Medical Center/Trauma and medical directions for the treatment of the patient must originate at that center.

In addition, adult trauma calls that meet Step 1 or 2 of the Trauma Field Triage Criteria Protocol and occur in the geographical area bordered by Paradise road to the east, Sunset Road to the north, Interstate 15 to the west, and the county line to the south, are to be transported to University Medical Center/Trauma and the medical directions for the treatment of the patient must originate at that center.

All trauma calls that meet the Trauma Field Triage Criteria Protocol, regardless of location, that are transported by air ambulance are to be transported to University Medical Center/Trauma and the medical directions for the treatment of the patient must originate at that center.

EXCEPTIONS:

1.  Nothing contained within these guidelines precludes transport to any trauma facility if, in the provider’s judgment, time to transport to the designated center would be unduly prolonged due to traffic and/or weather conditions and might jeopardize the patient’s condition.

2.  Additionally, nothing contained within these guidelines precludes transport to the closest facility if, in the provider’s judgment, an ability to adequately ventilate the patient might result in increased patient mortality.