The Major Trauma Triage Tool - London Trauma Office

The Major Trauma Triage Tool
Tracy Parr
London Trauma System Manager
London Trauma Office
Mark Faulkner
Paramedic Clinical Advisor to the Medical
Director
London Ambulance Service
March 2011

Triage
Trauma triage refers to the process of sorting patients according to the kind of injury,
severity of the injury and facilities available. “The ideal triage method would be applied
quickly and easily under field conditions, give consistent results among different
observers, and have a high rate of accuracy” (Eastman, 1987).
The goal of a triage system is to consistently get the right patient
to the right hospital in the right amount of time

Data Flow
Major Trauma Centre
Data Collectors
Input comprehensive data for TARN
analysis
Trauma Audit & Research
Network
LTO with validated , but non-patient
identifiable, data including ISS
TARN criteria:
All Trauma patients
72 hours stay
admitted high dependency
die in the hospital
transferred for specialist care
or a high dependency bed
Injuries meet the criteria
Major Trauma Centre
Emergency Department
Completes spreadsheet of all blue
light trauma patients
London Ambulance Service
Clinical Audit Research Unit
Matches LAS data and MTC to provide
complete list of Trauma Tree Positive
Patients Identifies LAS record and tree
triggers
London Trauma Office
Matches TARN record with LAS CARU
Trauma Tree Data
London Ambulance
Clinical Coordination
Desk
Collect & store pre-alert
ambulance data
Acknowledgements
•London Ambulance Service
•Clinical Co-ordination Desk
•Clinical Audit & Research
Unit
•Trauma Audit & Research
Network
•London Health Observatory
•Major Trauma Centres

Major Trauma Triage Tree

Map 1: All Trauma Tree Positive Patients 1 st April -
31 st July

All Trauma Tree Positive Patients 1 st April -31 st July to
Kings College MTC

All Trauma Tree Positive Patients 1 st April -31 st July to
Royal London MTC

All Trauma Tree Positive Patients 1 st April -31 st July to
St George's MTC

Triage Tool Triggers 1 ST June – 31 st July 2010
Total Triage Tool
triggers,
n=498
Assessment of Vital Signs & Level of Consciousness
(n=114, 23%)
Assess Anatomy of Injury
(n=227, 46%)
Assess Mechanism of Injury (n=44, 9%)
Assess Special Patient or System Consideration Cons. (n=11, 2%)
CCD/HEMS/BASICS (n=41, 8%)
Paediatric (n=58, 12%)

Major Trauma Decision Tree
Step One

Assessment of Vital Signs & Level of Consciousness
Vital Signs
(n=114)
GCS

Glasgow Coma Score
GCS 15
(n=46, 46%)
ISS 9 to 15 (n=4, 4%)
ISS 1 to 8 (n=4, 4%)
Admitted - Not TARN eligible
(n=34, 34%)
Discharged (n=11, 11%)

Systolic Blood Pressure less than 90mmHg
SBP 15
(n=2, 22%)
ISS 9 to 15
(n=2, 22%)
Admitted - Not TARN eligible
(n=3, 33%)
Discharged
(n=2, 22%)

Respiratory Rate 29 breaths per minute
RR 29
(n=6)
ISS 9 to 15
(n=3, 50%)
Admitted but not TARN eligible
(n=2, 33%)
Discharged
(n=1, 17%)

Major Trauma Decision Tree
Step Two

Assess Anatomy of Injury
Anatomy
(n=217)
Altered chest physiology
(n=18, 8%)
Penetrating trunk trauma
(n=141, 64%)
Pelvic #
(n=29, 13%)
Spinal trauma with abnormal
neurology (n=29, 13%)

Suspected Pelvic Fracture
Suspected Pelvic Fracture
(n=42)
ISS >15
(n=10, 23%)
ISS 9 to 15 (n=4, 23%)
ISS 1 to 8
(n=10, 23%)
Admitted - not TARN eligible
(n=12, 28%)
Discharged
(n=6, %)

Penetrating Trunk Injuries
Penetrating trunk trauma
triggers (n=141)
ISS >15 (n=11, 8%)
ISS 9 to 15 (n=7, 5%)
ISS 1 to 8 (n=5, 4%)
Admitted - Not TARN eligible
(n=56, 40%)
Discharged
(n=62, 44%)

Chest Injury With Altered Physiology
Chest injury with altered
physiology
n=18
ISS >15
(n=8, 44%)
ISS 9 to 15
(n=3, 17%)
ISS 1 to 8 (n=1, 6%)
Admitted not TARN eligible
(n=2, 11%)
Discharged
(n=4, 22%)

Major Trauma Decision Tree
Step Three

Assess Mechanism of Injury
Mechanism triggers
(n=44)
Bullseye windscreen and/or
damage to ‘A’ post of vehicle
(n=24, 52%)
Falls >20ft (two storeys)
(n=18, 43%)
Trapped under vehicle (n=1, 2%)
Assoc. fatality passenger compartment (n=1, 2%)

Bullseye windscreen / damage to ‘A’ post of vehicle
Bullseye windscreen and/or
damage to ‘A’ post of vehicle
(n=24)
ISS 9 to 15
(n=3, 13%)
Admitted - not TARN eligible
(n=8, 33%)
Discharged
(n=15, 17%)

Fall more than 20ft (two storeys)
Falls >20ft (two storeys) n=18
ISS >15
(n=7, 37%)
ISS 9 to 15
(n=2, 11%)
ISS 1 to 8
(n=2, 11%)
Admitted - not TARN eligible (n=1, 5%)
Discharged
(n=6, 32%)

All MTCs Triage Tool Positive patients by time of admission
06/04/10 to 31/05/10, n=541
Number of patients
45
40
35
30
25
20
15
10
5
0
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24
Hour of the day

Journey times (minutes) from scene of incident to
arrival in MTC for triage tool positive patients
May and June 2010 (n = 501)

All MTCs Triage Tool Positive patients
06/04/10 to 31/07/10, n=1,088

Future Work
o Expand data set
o Work with London Health Observatory to
undertake sensitivity and specificity of
section of trauma tool
o True negatives
o Thematic analysis of ISS >15 in Trauma
Units
o Review tool

Thanks
Mark.Faulkner@Lond-Amb.nhs.uk
Tracy.Parr@LondonTraumaOffice.nhs.uk