Updated Trauma Triage Guidelines offer a chance to re-focus on trauma
Take advantage of new resources to prevent over- and under-triage, and to guide transportation decisions
It seems that the headlines for the last few years have seen quite a few more medical topics than usual. The trend started with news of the novel coronavirus, of course, which morphed into endless stories about COVID-19. It seems like every day during 2020 and 2021, we had updates about what COVID was, how it was transmitted, PPE protocols for responders and steps to be taken when EMS providers were exposed or tested positive.
The news about COVID has slowed a little this year, at least in EMS circles, but they have been replaced by articles about Monkeypox, forecasts for a harsh influenza season and even the return of Ebola outbreaks in Africa. Deaths related to opioid overdoses have become an epidemic in their own terms, ravaging all sectors of the population, leading to a variety of important new programs to prevent and treat the problem.
In the meantime, trauma continues to be a leading cause of death, devastating injuries and loss of productivity and income. In terms of headlines, just a few of the traumatic events that made news in recent years included:
- Uvalde, Texas, school shootings
- Stabbing murder of FDNY EMS Cpt. Alison Russo
- Las Vegas Strip stabbing deaths
- Buffalo supermarket mass shooting
- Surfside condo collapse in Florida
- Astroworld Festival concert crush
Preparing for trauma
As we close out 2022 and look forward to 2023, EMS providers should make a resolution to keep a focus on preparing for trauma. Not only is it clear that traumatic incidents still occur, but we know that no communities are immune. School shootings and other active threat scenarios don’t just happen in the big cities. Transportation crashes and manufacturing or construction mishaps are as likely in the suburbs and rural settings as in urban centers. All systems – big and small – must be prepared for the worst.
An important part of preparing to give high-quality care to trauma patients is to have a plan to get the right patients to the right level trauma center using the right transportation resources. The recently revised National Guidelines for the Field Triage of Injured Patients is a tool that helps responders do just that. Using information that EMTs and paramedics gathered during their scene, primary and secondary assessments, patients can be categorized as high, moderate or low risk for serious injury.
From there, providers use information about their local trauma system to identify the most appropriate trauma center destination for the patient. Some of the local factors that must be considered include:
- Level of care provided by local ambulances
- Ability of local ambulances to transport to distant trauma centers
- Availability of medical helicopters
- Distances to higher-level trauma centers
- Trauma capabilities of local community hospitals
By using the Guidelines, we limit the number of patients that are transported to high-level trauma centers when they do not need to be. Keeping a handle on over-triage is important when hospitals are struggling with staffing shortages, limited beds and increased wait times in emergency departments.
Use of the Guidelines also minimizes dangerous under-triage, where severely injured patients do not get the care they need or have that treatment delayed by being sent to a hospital that cannot provide the necessary resources. Traditionally, the American College of Surgeons Committee on Trauma has considered an over-triage rate of 35% acceptable while expecting less than 5% under-triage. A higher over-triage rate helps limit under-triage, but it must be balanced with the limited resources of the higher-level trauma centers.
Likewise, the Guidelines can be used to determine how a patient should be transported to a trauma center. Depending on resources available to you, maybe your system will designate patients that meet red criteria as those who should be flown by helicopter or lights and sirens transport if going by ground ambulance.
Each service should work with their medical director, trauma centers, dispatch centers and other providers in the region to establish a plan to implement the Guidelines in:
- Dispatch protocols
- Treatment guidelines
- Destination determination criteria
- Transport procedures
Once the Guidelines are established and trained within your system, quality improvement reviews should monitor compliance and guide continuing education.
Take advantage of the revised National Guidelines for the Field Triage of Injured Patients to strengthen the trauma care your service provides. The American College of Surgeons provides more information about the Guidelines, including details about the updated criteria, training materials and quality improvement performance measures.
Stay safe out there.
Field Triage Guideline – A new look and important updates
Learn what’s changed in the 2021 ACS FTG and how to implement the trauma triage guidelines