2011 Guidelines for Field Triage of Injured Patients

Guidelines for Field Triage of Injured Patients

Recommendations of the National Expert Panel on Field Triage, 2011 

MMWR. 2012;61:1-20.

Step 1: Physiologic Criteria

• GCS ≤13
• SBP <90 mmHg
• Respiratory Rate <10 or >29 breaths per minute (<20 in infants aged <1 year) or need for ventilatory support

Step 2: Anatomic Criteria

• All penetrating injuries to head, neck, torso, and extremities proximal to elbow or knee
• Chest wall instability or deformity (e.g., flail chest)
• Amputation proximal to wrist or ankle
• Two or more proximal long-bone fractures (i.e., femur and humerus)
• Crushed, degloved, mangled, or pulseless extremity 
• Pelvic fractures
• Open or depressed skull fracture
• Paralysis

Step 3: Mechanism of Injury Criteria

• Adult: falls >20 feet
• Children: falls >10 feet
• Intrusion, including roof: >12 inches occupant site; >18 inches any site
• Ejection (partial or complete) from automobile
• Death in same passenger compartment
• Vehicle telemetry data consistent with a high risk of injury
• Auto vs. pedestrian/bicyclist thrown, run over, or with significant (>20mph) impact
• Motorcycle crash >20 mph

Step 4: Special Considerations

• Age >55 years
• SBP <110 in persons aged >65 years
• Falls in older adults (e.g., ground-level falls)
• Pediatric trauma transport 
• Anticoagulant use and bleeding disorders
• Burns
• Pregnancy >20 weeks
• EMS provider judgment

Outcome Variables
Clinical outcomes

• Injury severity score >15
• Abbreviated Injury Score ≥3
• Death prior to hospital discharge

Trauma center need

• Blood product transfusion
• Interventional radiology procedure
• Major non-orthopedic surgery within 24 hours
• Admission to ICU