National Guideline For The Field Triage of Injured Patients

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High Risk for Serious Injury

Injury Patterns

  • Penetrating injuries to head, neck, torso, and proximal extremities
  • Suspected spinal injury with new motor or sensory loss
  • Chest wall instability, deformity, or suspected flail chest
  • Suspected pelvic fracture
  • Suspected fracture of two or more proximal long bones
  • Crushed, degloved, mangled, or pulseless extremity
  • Amputation proximal to wrist or ankle
  • Active bleeding requiring a tourniquet or wound packing with continuous pressure

Mental Status & Vital Signs

All Patients

  • Unable to follow commands (motor GCS <6)
  • RR <10 pr >29 breaths/min
  • Respiratory distress or need for respiratory support
  • Room-air pulse oximetry <90%
  • SBP <70 mm Hg + (2 x age in years)

Age 0-9 years

  • SBP <70 mm Hg + (2 x age in years)

Age 10-64 years

  • SBP <90 mm Hg or HR > SBP

Age ≥ 65 years

  • SBP < 110 mmHg or HR > SBP

Patients meeting any one of the above RED criteria should be transported to the highest-
level trauma center available within the geographic constraints of the regional trauma


Moderate Risk for Serious Injury

Mechanism of Injury

  • High-risk auto crash
    • Partial or complete ejection
    • Significant intrusion (including roof)
      • > 12 inches occupant site OR
      • > 18 inches any site OR
      • Need for extrication for entrapped patient
    • Death in passenger compartment
    • Child (age 0-9 years) unrestrained or in unsecured child safety seat
    • Vehicle telemetry data consistent with severe injury
  • Rider separated from transport vehicle with significant impact (e.g., motorcycle, ATV,
    horse, etc.)
  • Pedestrian/bicycle rider thrown, run over, or with significant impact
  • Fall from height >10 feet (all ages)

EMS Judgment

Consider risk factors, including:

  • Low-level falls in young children (age ≤ 5 years) or older adults (age ≥ 65 years) with
    significant head impact
  • Anticoagulant use
  • Suspicion of child abuse
  • Pregnancy > 20 weeks
  • Burns in conjunction with trauma
  • Children should be triaged preferentially to pediatric capable centers

If concerned, take to a trauma center

Patients meeting any one of the YELLOW CRITERIA WHO DO NOT MEET RED CRITERIA
should be preferentially transported to a trauma center, as available within the geographic
constraints of the regional trauma system (need not be the highest-level trauma center).

If you have any other questions, please feel free to reach out to [email protected]

Download the complete tip, National Guideline for the Field Triage of Injured Patients.