Preparation and Triage

This occurs in the field and in the hospital.

Preparation

Prehospital Phase

In this phase, the receiving hospital is notified before the patient is transported from the scene. This allows for mobilization of the trauma team members so everyone is present in the ER at the time of the patient's arrival.

In this phase, airway maintenance, control of external bleeding and shock, immobilization, and immediate transport is prioritized. Scene time is minimized.

Who should be transported to a trauma center?

  1. GCS 13 or less, SBP 90 or less, respiratory rate less than 10 or greater than 29, or needs ventilatory support.
  2. Penetrating injury to the head, neck, torso and extremities proximal to the elbow and knee
  3. Chest wall instability, or deformity
  4. Two or more proximal long bone fractures
  5. Crushed or deformed extremity
  6. Linda, amputation, proximal to wrist or ankle
  7. Pelvic fractures
  8. Open or depressed skull fractures
  9. Paralysis
  10. Falls >20 feet in adults and >10 feet in children
  11. High risk motor vehicle crashes
  12. Auto versus non-auto pedestrian with significant impact
  13. Motorcycle crashes
  14. Older adults
  15. Children
  16. Anticoagulant use and bleeding disorders
  17. Burns
  18. Pregnancy > 20 weeks
  19. EMS provider judgement

Hospital Phase

Handover between pre-hospital providers and receiving hospital providers should be smooth and directed by the trauma team leader.

Ensure the following are present: resuscitation area, functional and accessible airway equipment, warmed IV crystalloid solutions and monitoring devices, protocols to summon additional medical assistance, including laboratory and radiology personnel.

Triage