Trauma Alert Guidelines

Past Initial Triage

For patients who are past the triage process and in an ED room:

• Upgrading to Level I or II after patient is established in the ED should only be secondary to rapidly deteriorating GCS or SBP <90.

• Do not upgrade based solely on mechanism after the patient is already established/triaged (e.g. you found out that the patient had a MVC rollover, or MCC ejection), but get a trauma consult instead if indicated.

Trauma Alert Categories

Level 1 Trauma

1. Patient with traumatic mechanism is apneic and/or pulseless
2. Glasgow Coma Scale <9 with mechanism attributed to trauma
3. Gunshot wounds to the head, neck, chest, or abdomen.
4. Shock present with mechanism attributed to trauma:
   a. Systolic Blood Pressure <90 at any point in the adult patient
   b. Sustained HR>SBP
   c. Any patient receiving blood to maintain vital signs
5. Transfer patients who require ongoing blood transfusion
6. Hangings and Drownings WITH near cardiac and/or respiratory arrest
7. Near cardiac and/or respiratory arrest with traumatic mechanism - includes field intubations

Level 2 Trauma

1. Penetrating injuries (stab wounds) or impalement to the head, neck, chest, abdomen, or extremities proximal to the wrist or ankle
2. Active bleeding requiring a tourniquet or wound packing with continuous pressure
3. MVC with:
   a. Death of another occupant of the same vehicle
   b. Partial or complete ejection
   c. Child (0-9 years old) unrestrained or unsecured
   d. Vehicle telemetry data consistent with severe injury
   e. MVC vs pedestrian/bicycle a suspected speed of > 5 m.p.h.
   f. MCC/ATV/Other transport vehicle with rider separated and high energy impact
4. Fall
   a. Greater than 20 feet
   b. For pediatrics: Fall > 10 feet or 2X their height
5. Neuro
   a. Suspected skull fracture
   b. Suspected spinal cord injury with new motor/sensory loss
   c. Loss of consciousness > 5 min with mechanism attributed to trauma
6. Ortho
   a. Suspected fracture of two or more long bones
   b. Crushed, degloved, mangled, or pulseless extremity
   c. Amputation proximal to the wrist or ankle
   d. Open fractures above the wrist or ankle or multiple fractures due to high energy transfer
   e. Pelvic fractures
7. Geriatric
   a. HR >90 with mechanism attributed to trauma
   b. SBP <110 with mechanism attributed to trauma
   c. GLF on anticoagulation/antiplatelets excluding ASA
           i. If significant bleeding is present
           ii. With signs/symptoms of head trauma (different from baseline)
8. High index of suspicion for potential injury based on age (less than 5 years or greater than 65 years) and/or mechanism of injury
9. History of trauma in a patient with significant medical comorbidities (cardiac disease, respiratory disease, cirrhosis, pregnancy, immunosuppression, coagulopathy, history of anticoagulants)

Level 2 Intubated Trauma

This trauma alert can only be given by the Ascension Via Christi attending trauma surgeon after direct consultation with the outlying facility’s provider confirming respiratory status is stable and airway is secure.

Critical Burn Alert

Code Red Burn Alerts AND one or more of the following criteria:
a. Patient is apneic and/or pulseless
b. Airway compromise (includes respiratory distress or failure, stridor, wheezing, etc.)
c. Blood pressure <90 at any point in adults, age specific in children (see above)

Notes: Burn alerts WITH traumatic mechanism (explosion, MVC with fire, associated falls, etc.) are triaged according to Trauma Alert Criteria.