Trauma Classification

1
Trauma Classification

• Statewide BLS Protocols
• Updated November 1, 2006

2
Objectives

• At the completion of this program, students will
• Understand proper categorization of trauma
  patients
• Understand appropriate uses of air ambulance
  transportation
• Appropriately categorize trauma patients through
  the use of case studies

3
Protocol Background

• 3 categories of trauma triage based upon the most
  up-to-date evidence and patient outcome
• Provides recommendations for the use of air
  ambulance transport
• Provides direction related to when medical
  command should be contacted to assist with
  destination decisions

4
Protocol Exclusion

• Patients transported by an air ambulance
• Destination is determined by air ambulance
  personnel using a different protocol
• Ground services do not determine the receiving
  hospital in this situation

5
Trauma Patient Categories

• Category 1 severe injury that will benefit from
  trauma center care
• Category 2 significant mechanism of injury that
  may benefit from trauma center care
• Category 3 minimal potential for severe injury
  and should be treated at a local hospital

6
Whats that mean?

• Essentially
• Category 1 major trauma patients
• Category 2 significant mechanism of injury
• Category 3 everything else

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Category 1 Trauma Patients
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Category 1

• Does not follow commands
• (GCS Motor 5)
• Hypotension, even single episode
• Systolic lt90 in adults of lt70 in children
• Penetrating injury to head, neck, torso and
  proximal to elbows/knees
• Chest injuries with respiratory difficulty

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Category 1 (contd)

• Two or more femur/humerus fractures
• Pelvic fractures
• Paralysis, weakness, sensory deficit from spinal
  cord injury
• Amputation above wrist/ankle

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Category 2 Trauma Patients
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Category 2

• Death of another occupant in same vehicle
• Auto vs. pedestrian/bicycle injury with
  significant impact
• Pedestrian thrown/run over
• Extrication time gt20 minutes

12
Category 2 (contd)

• Falls gt 20 feet
• Ejection from vehicle
• Vehicle rollover
• High-energy crash
• Motorcycle crash with separation

13
Category 2 (contd)

• Rigid, tender abdomen
• Age lt5 or gt55 years old
• Combination of trauma and burns
• Known heart disease, CHF or COPD
• Bleeding disorder or taking Coumadin or Heparin
• Pregnancy gt20 weeks
• Amputation of fingers with possibility of
  reattachment

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Category 3 Trauma Patients
15
Category 3

• Any patient that does NOT meet criteria for
  Category 1 or 2

16
Destination Decisions

• Extremely critical patient that is rapidly
  worsening
• Take to closest hospital (regardless of trauma
  center status)
• Examples Unable to establish open airway or
  ventilate

17
Destination Decisions

• Category 1 Trauma patient
• Direct to Trauma Center (do not pass go, do not
  stop and collect 200)

18
Destination Decisions

• Category 2 Trauma Patients
• In Chester County Call medical command before
  making a decision, if in doubt
• Category 3 Trauma Patients
• Take to local hospital
• There is no need to consult medical command on
  these patients, they go to a local hospital

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Air Ambulance use

• Category 1
• Consider air transport when
• Air can deliver patient to trauma center faster
  than ground (be sure to consider travel time,
  package time, etc)
• GCS 8 and aircraft ETA to scene is less than
  ground transport time

20
Air Ambulance use

• Category 2
• Consider air transport if transport by ground
  will take gt 30 minutes
• MUST have medical command OK

21
Air Ambulance use

• Category 3
• NEVER

22
Important Notes

• Loss of Consciousness is NOT a factor for triage
  to a trauma center

23
Pediatrics

• Pediatric patients 14 years old (Category 1 and
  2)
• Should be transported to the closest hospital if
  extremely critical and rapidly worsening
  (example unable to open airway or ventilate
  adequately)
• Should be transported to a trauma center with
  pediatric accreditation if this only increases
  the transport time to the closest trauma center
  by 10 minutes

24
Medical Command

• For questions regarding destination/mode for
  Category 1 or 2 trauma patients, contact a
  medical command facility in the following order
  of preference
• The receiving trauma center if known
• The closest trauma center
• The local facility

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Scenario 1
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Scenario 1

• A 65 year old woman is involved in a motor
  vehicle crash. She was the front seat,
  restrained passenger. The driver of the car died
  at the scene.
• Airway Clear
• Breathing Bilateral, equal air entry
• Circulation Pulse 80/mon, BP 190/110
• Dysfunction Obvious head injury. GCS 5 (E1 V1
  M3), Dilated left pupil
• Exposure No other obvious injuries

Cat 1
Cat 2
Cat 3
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Scenario 2
28
Scenario 2

• A 43 year old woman has been stabbed by her
  husband in the left abdomen. Apparently she
  burnt the dinner one too many times. You are 45
  minutes by ground to the closest Trauma Center.
• Airway Clear
• Breathing Respiratory rate 14, Bilateral, equal
  air entry
• Circulation Pulse 90/min, BP 130/70
• Dysfunction GSC 15
• Exposure Evisceration obvious in left abdomen

Cat 1
Cat 2
Cat 3
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Scenario 3
30
Scenario 3

• 24 year old man, head on collision at high speed
  with a house
• Airway Clear
• Breathing Respiratory rate 28, Bilateral, equal
  air entry. Diaphragmatic breathing pattern
• Circulation Pulse 130/min, BP 70/30
• Dysfunction GSC 10. No movement or sensation
  below C5
• Exposure No other obvious injury

Cat 1
Cat 2
Cat 3
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Scenario 4
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Scenario 4

• 51 year old male motorcycle rider, lost control
  and traveled 25 feet with motorcycle. Patient
  was not wearing a helmet.
• Airway Clear
• Breathing 18/min, bilateral, equal air entry
• Circulation Pulse 76/min, BP 142/94
• Dysfunction No deficits noted
• Exposure Abrasion to left hand, right knee,
  deformity to right ankle (good pulse and
  sensation)

Cat 1
Cat 2
Cat 3
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Scenario 5
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Scenario 5

• 60 year old male fell down 6 stairs and struck a
  wooden floor. Patient was reported to be
  unconscious for about 2 minutes.
• Airway Clear
• Breathing 16/min, bilateral, equal air entry
• Circulation Pulse 62, BP 117/72
• Dysfunction No deficits noted
• Exposure No injury noted

Cat 1
Cat 2
Cat 3
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Scenario 6
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Scenario 6

• Patient is a 30 year old male motorcycle rider,
  wearing his helmet. He was traveling at 50mph
  when he lost control and separated from his bike.
• Airway Clear
• Breathing 16/min, bilateral, clear equal air
  entry.
• Circulation Pulse 65/min, BP 130/80
• Dysfunction No deficit noted
• Exposure Abrasions to left hip, large abrasion
  to left flank. Multiple abrasions to lower arms
  and hands. Fingers on left hand with abrasions
  and avulsions. Good Pulse, Motor, and Sensation
  in all extremities.

Cat 1
Cat 2
Cat 3
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Scenario 7
38
Scenario 7

• Patient is a 20 year old female who rolled her
  vehicle 3-5 times, landing in a field.
• Airway Clear
• Breathing 24/min, bilateral, clear equal air
  entry
• Circulation Pulse 100, BP 114/92
• Dysfunction No deficits
• Exposure Pain in middle of neck, abdominal pain
  upon inspiration, pain in back. Abdomen soft,
  tender upon palpation in right upper and lower
  quadrant and left lower quadrant. Bruising
  present across lower abdomen from right to left
  side. Guarding. Tenderness across pelvic
  girdle. Swelling to right arm, pain upon
  movement. Right hand swollen.

Cat 1
Cat 2
Cat 3
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Scenario 8
40
Scenario 8

• Patient is a 35 year old male who was involved in
  a low speed motor-vehicle accident
• Airway Clear
• Breathing 16/min, bilateral, clear equal air
  entry
• Circulation Pulse 76/min, BP 160/100
• Dysfunction No deficits
• Exposure Laceration on right side of head
  Pupils equal and reactive to light

Cat 1
Cat 2
Cat 3
41
Scenario 9

• Patient is a 17 year old female who fell from a
  standing position onto a carpeted surface
• Airway Clear
• Breathing 18/min, bilateral, clear equal air
  entry
• Circulation Pulse 86/min, BP 110/76
• Dysfunction No deficits
• Exposure Swollen left ankle

Cat 1
Cat 2
Cat 3
42
Scenario 10

• Patient is a 92 year old female who fell, in a
  nursing home, from a standing position onto a
  wooden floor
• Airway Clear
• Breathing 20/min, bilateral, wheezing
• Circulation Pulse 62/min, BP 100/60
• Dysfunction Patient is conscious, alert,
  oriented to time and history of events,
  disoriented to person and place. Patient has a
  history of Alzheimer's Disease
• Exposure Patient complains of hip tenderness
  upon palpation

Cat 1
Cat 2
Cat 3
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CORRECT!

• Where would you transport this patient?

Not sure, Call Medical Command
Trauma Center
Local Hospital
44
CORRECT!

• Where would you transport this patient?

Trauma Center
Local Hospital
Not sure, Call Medical Command
45
CORRECT!

• Where would you transport this patient?

Trauma Center
Local Hospital
Not sure, Call Medical Command
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CORRECT!

• Where would you transport this patient?

Trauma Center
Local Hospital
Not sure, Call Medical Command
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CORRECT!

• Where would you transport this patient?

Trauma Center
Local Hospital
Not sure, Call Medical Command
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CORRECT!

• Where would you transport this patient?

Trauma Center
Local Hospital
Not sure, Call Medical Command
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CORRECT!

• Where would you transport this patient?

Trauma Center
Local Hospital
Not sure, Call Medical Command
50
CORRECT!

• Where would you transport this patient?

Trauma Center
Local Hospital
Not sure, Call Medical Command
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CORRECT!

• Where would you transport this patient?

Trauma Center
Local Hospital
Not sure, Call Medical Command
52
CORRECT!

• Where would you transport this patient?

Trauma Center
Local Hospital
Not sure, Call Medical Command
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CORRECT!

• How would you transport this patient?

Air Medical
Ground
Not sure, Call Medical Command
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CORRECT!

• How would you transport this patient?

Air Medical
Ground
Not sure, Call Medical Command
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CORRECT!

• How would you transport this patient?

Air Medical
Ground
Not sure, Call Medical Command
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CORRECT!

• How would you transport this patient?

Air Medical
Ground
Not sure, Call Medical Command
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CORRECT!

• How would you transport this patient?

Air Medical
Ground
Not sure, Call Medical Command
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CORRECT!

• How would you transport this patient?

Air Medical
Ground
Not sure, Call Medical Command
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CORRECT!

• How would you transport this patient?

Air Medical
Ground
Not sure, Call Medical Command
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CORRECT!

• How would you transport this patient?

Air Medical
Ground
Not sure, Call Medical Command
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CORRECT!

• How would you transport this patient?

Air Medical
Ground
Not sure, Call Medical Command
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CORRECT!

• How would you transport this patient?

Air Medical
Ground
Not sure, Call Medical Command
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Not wrong, but there is a better answer. Try
again.
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Thank you!

• Thank you for completing this program. It is our
  hope that you will better understand the
  classification system for trauma patients and
  help to decrease the number of mistriaged
  patients and unnecessary flights.

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Exam

• In order to receive continuing education credits,
  you must now complete a 10 question written exam.
  You can find the exam on the website. You will
  be notified of your results via e-mail within 72
  hours.
• If you have any questions, please e-mail
  rkagel_at_chesco.org