EMS providers shall assess each adult and pediatric trauma patient using the following criteria upon contact.
- Once a level 1 trauma alert patient is identified in the field through assessment, a crew member must contact GMH via recorded line as soon as practical and provide a full report.
- The words “Trauma Alert” must be included in the report.
- All patients meeting the criteria listed below shall be transported to Greenville Memorial Hospital (Level 1 Trauma Center).
- If patient refuses transport to GMH and is deemed a “Trauma Alert” by the EMS professional, a refusal must be signed for alternate transport destination after explaining the risk of “life and limb” to the patient.
Upon arrival in the Trauma bay EMS personnel will give a brief report to the trauma team by using the “M.I.S.T.” report.
- Age and Sex
- GCS (3-15)
Mechanism of Injury:
- Entrapment duration (PRN)
Injuries Sustained (Airway):
- Secured (Open, ETT, King)
- does anesthesia need to come immediately
- injuries identified or suspected
- Does a surgeon need to scrub out of a case and come down immediately
- The receiving medic may request a systolic blood pressure, but trauma services agreed to utilizing the term “stable or unstable hemodynamics
Trauma Criteria Level 1:
A Level 1 (Full) Alert should be activated on any patient meeting one or more of the following criteria:
- Glasgow coma score (GCS) ≤ 11
- Injury with associated Tachycardia and poor perfusion
- Systolic BP < 90 or for PEDS ≤ 70 + 2x (age in years
- Respiratory rate <10 or >29 or when the patient is in respiratory distress, has had a pleural decompression or is intubated.
- Penetrating injury /wound to head, neck, torso, or extremities proximal to the elbow or knee
- Paralysis related to trauma
- Crushed, de-gloving, mangled, or pulseless extremity proximal to the elbow & knee
- Thermal injuries including 2nd or 3rd degree burns ≥ 20% TBSA
- Electrocution with high voltage: ≥ 220 volts or > than household current
- Transferred patients receiving blood products related to trauma
- Active bleeding requiring a tourniquet or uncontrolled hemorrhage if injury is proximal to the elbow and/or knee.
- Discretion of any trauma team member
High Index of Suspicion / Factors to Consider (For activation or upgrade in activation)
- Age > 55 years with significant mechanism of injury
- Extrication time > 20 minutes
- Cardiac or respiratory disease
- Insulin dependent diabetes
- Morbid obesity
- Immunosuppressed patients
- Patient with bleeding disorder
- Patients on anticoagulants