UMEM Educational Pearls

Category: Misc

Title: EMS Pearls: Field Triage of Injured Patients and the MMWR

Keywords: EMS, trauma, injury, ISS, triage (PubMed Search)

Posted: 1/22/2009 by Ben Lawner, DO (Updated: 7/21/2019)
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BACKGROUND: 

For the first time since its publication, the centers for disease control has dedicated an entire issue of their Morbidity and Mortality Weekly Report to an emergency medical services topic. Vol 55 RR-1 reviews the, "Guidelines for Field Triage of Injured Patients." The report represents a consensus opinion of national experts in EMS, EM, and trauma care. It outlines which patients may be best served via transport to a trauma center.

CRITERION LINKED TO SEVERE INJURY  (Consider transport to nearest TRAUMA CENTER) 

  • GCS < 14, SBP < 90 mm Hg, RR < 10 or > 29 per minute (or less than 20 for infants) 
  • Penetrating wounds to neck, torso, head
  • Flail chest, two or more proximal long bone fractures
  • Proximal extremity amputation
  • Paralysis
  • Open or depressed skull fracture
  • Older patients on anticoagulation

From the MMWR: "The National Study on the Costs and Outcomes of Trauma identified a 25% reduction in mortality for severely injured patients who received care at a Level I trauma facility." 

EXTRAS: 

The remainder of the report details the triage decision making process, explains trauma center capabilities, and provides an interesting and detailed review of trauma transport criteria. Link to the current issue is attached.

http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5801a1.htm