By Maveric Vu
EMS1 News Editor
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ATLANTA — Step-by-step criteria for determining which patients should go to specialized trauma centers have been outlined in a new report.
The guidelines by the Centers for Disease Control provide a general framework for assessing trauma patients by making sure severely injured patients have priority to get to trauma centers, according to authors.
“We need all EMTs to use the guidelines each and every time they care for someone who’s injured,” said CDC director Dr. Richard Hunt during a conference call Wednesday.
Injury is the leading cause of death for people ages one to 44 years old, according to the report, and severely injured patients who receive specialized care at a trauma center are 25 percent less likely to die from injures.
The Guidelines for Field Triage of Injured Patients outlined four, step-by-step criteria that prioritize assessment decisions.
- Step One: Vital signs and level of consciousness
- Step Two: Type and severity of injury
- Step Three: How the injury occurred
- Step Four: Special considerations like age, pregnancy and burns
Under steps one and two, a patient who places less than 14 on the Glasgow Coma Scale or who has a flail chest should be “transported preferentially to the highest level of care within the trauma system.”
A patient involved in a high-risk car crash, without meeting the first two criteria, should be transported to the closest facility. Children and the elderly who do not fulfill any of these previous requirements would need to be evaluated by a medical director.
The decision formula, first published by the American College of Surgeons in 1986, was established to “identify those patients who are at greatest risk for severe injury,” and help find an “optimal way to reduce morbidity, mortality, and economic consequences of injuries.”
According to the report, one such trend for optimization was the concept of “bypassing closer facilities in favor of those with enhanced capabilities for treating severely injured patients.” An expert panel used this concept of trauma care, along with an injury scale formula, in order to determine field triage guidelines.
However, some representatives from the automobile industry questioned criteria chosen for the steps, stating that the omission of roll-over crashes would result in more deaths of patients.
Dr. Scott Sasser, with CDC’s injury response division, responded that “paramedic judgment” should always be used when in doubt regardless of meeting criteria items.
Statistics show ejection from a vehicle was a more significant factor in injury than the rolling of a vehicle, he added.
If patients involved in a roll-over crash are not picked up by steps one or two, then they may not mandate the highest level of trauma care, he said.
By setting down guidelines for patient transport, Hunt said he hopes to both improve survivability and reduce unnecessary costs of overburdened trauma systems.
According to the report, patients whose injuries required medical treatment in 2000 were associated with an estimated $80 billion in medical costs and $326 billion in productivity losses. In 2003, about 30 million ED visits (26 percent) were for nonfatal injuries, and jumped to 41 million visits by the following year.
“It’s about the right person, at the right place, at the right time,” Hunt said. “There is a real cost savings of having those who are not severely injured, but who indeed need care, at non-trauma centers.”
Hunt said he hopes to make “substantial progress” nationwide by 2010, and will work with communities to help adopt and integrate the guidelines into existing protocols. The report, revised in 2006, is the “first of its kind,” according to Hunt.
“We also recognize that certainly with a first-time endeavor, even with multiple agencies involved, that we certainly could’ve missed things,” he said.
He added that the challenge of implementing field triage guidelines comes from a lack of data available in EMS. Getting feedback will help improve that data, he said, and encouraged all responders to offer their views and comments.
The guidelines are supported by 17 organizations including the National Association of Emergency Medical Technicians, the National Association of EMS Educators, the National Association of EMS Physicians and the National Highway Traffic Safety Administration.
To view the report, as well as download a printable “Decision Scheme,” visit www.cdc.gov/fieldtriage.