Trauma Patient Triage and Destinations - Eastern EMS Council

Review of trauma triage protocols and patient 

destination decisions and mode of transport 

Presented by 

Everitt F. Binns, Ph.D 

Executive Director 

And 

Ed Moreland 

Director of EMS Quality Improvement 

Eastern PA EMS Council 

4801 Kernsville Road 

Orefield, PA 18073 

www.easternemscouncil.org 

Copyright Eastern PA EMS Council, 2007

Objectives 

• Review of Trauma patient Categories 

• Review of Trauma Center classifications and 

definitions 

• Review of non‐trauma air ambulance protocol 

• Review of destination decisions and modes 

• Examples 

• Discussion 


Trauma Patient Categories 

• Currently three (3) categories of trauma patients 

• Category I=Life threatening injuries 

• Category II=Mechanism of injury with increased index 

of suspicion 

• Category III=Minor trauma 

• Found in Statewide Protocol 180 

• We’ll come back to this later 


Category I Trauma Patients 

• Does not follow commands (motor GCS ≤ 5) 

• Hypotension, even single episode 

– SBP

Category II Trauma Patients 

• Death of another occupant in same vehicle 

• Auto vs. pedestrian (bicycle) injury with significant impact 

• Pedestrian thrown/ run over 

• Extrication time > 20 minutes 

• Falls > 20 feet 

• Ejection from vehicle 

• Vehicle rollover 

• High‐energy crash 

• Motorcycle crash with separation of rider from motorcycle 

• Rigid, tender abdomen 

• Age 55 y/o 

• Combination of trauma and burns 

• Known heart disease, CHF, COPD 

• Bleeding disorder or taking coumadin or heparin 

• Pregnancy > 20 weeks 

• Amputation of fingers with possibility of reattachment 



Trauma Centers 

• Regulated and Recognized by Pennsylvania Trauma 

Systems Foundation (PTSF) 

• Legislatively mandated organization that maintains 

the trauma registry, establishes and regulates trauma 

center requirements 

• Historically two levels of trauma centers 

• Good Samaritan‐Pottsville is first Level III in the 

Commonwealth 



• Level I 

• Residency Programs, research, literature publication 

• Specialties 

• Level II 

• No Residence requirements 

• No research requirements, no publications required 

• Less physician specialties and sub‐specialty 

requirements 



• Level III 

• Designed to fill a void in trauma center availability to 

rural areas of the Commonwealth 

• Modeled after other state’s systems 

• Requires formation of trauma registry 

• Physicians, Nurses(ED, Surgery, other specialties) 

required to have additional training 

• Increased availability of equipment and specialties 



• Level III 

• Not intended to replace or substitute for Level I or II 

trauma centers, but to augment 

• Increases access to enhanced care for patients that may 

not otherwise receive it 


Trauma Center Distribution 

• 28 Accredited Trauma 

Centers (not including 

Good Samaritan) 

• 15 Level I 

• 11 Level II 

• 8 Pediatric (additional 

qualification) 


Where do we go and how do we 

get there 

• Extremely Critical Trauma Patients 

• (e.g. no airway, can’t ventilate, uncontrolled bleeding) 

–Transport to closest hospital 

ASAP 



get there 

• Category I trauma patients 

• Still need to go to Level I or II Trauma Center 

• Utilize the mode that will get them to the Trauma 

Center in the shortest time 

• Include warm up, enroute time, landing, handoff and flight 

time to trauma center for estimating flight time 

• Consider rendezvous with air ambulance en‐route to trauma 

center 



get there 

• Category II Trauma Patients 

– Transport to closest Level I, II, III Trauma Center if 

arrival is less than 45 minutes by ground 

– If arrival to a trauma center cannot be reached within 45 

minutes, then transport should be to the closest ED 

– Consider air transport if ground transport is greater 

than 30 minutes 

– Communicate ETA to receiving trauma center as soon as 

possible so that trauma center can mobilize their trauma 

team 



get there 

• Category III Trauma Patients 

• Transport to closest hospital 


How do we get them to the Trauma 

Center 

• Category 1: consider air transport if: 

– Can deliver patient to TC faster than ground 

– GCS ≤ 8 and aircraft ETA to scene is less than ground 

transport time 

• Category 2: consider air transport if: 

– Transport by ground will take > 30 minutes 

• Avoid prolonged delays on scene awaiting arrival 

of air ambulance 

• Consider use of hospital/established helipads 

• Helicopter transportation is not indicated in 

traumatic cardiac arrest 


Transport Decision 

• No Air Ambulances will transport patients to Level III 


• In Pottsville‐Transport Trauma patients to Good 

Samaritan 

• Outside Pottsville, consider Air Ambulance for 

Category I and II patients 




Non‐Trauma Use of Air Ambulance 

• Designed for STEMI and CVA 

• Allows for usage other than above 

• STEMI usage requires positive 12‐lead EKG 

• CVA usage requires normal activity within 2 hours 

• MUST BE COMMAND DIRECTED 

• Use caution, antecdotal reports of non‐trauma 

seizures, overdoses, and other invalid uses 


Case Review 

• Auburn 

• Fall from 15 feet, positive LOC, open tib/fib fx 

• BP 96/60, RR 28, PEARL, Left side chest tenderness 

• Weather is clear, sunny 

• Where and how does this patient get to the hospital 


Case Review 

• Ashland 

• 10 yom, struck while riding his bicycle 

• Chest pain, Resp distress, SPO2 95%, fx pelvis 

• BP 80/60, 

• Raining 

• Where and how 


Questions

Trauma Patient Triage and Destinations - Eastern EMS Council

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