TRAUMA

Inclusion Criteria:  Patients with traumatic injuries.  If patient suffers a cardiac arrest due to trauma, refer to CARDIAC ARREST Guidelines.  Treat pain according to the PAIN MANAGEMENT Guidelines.

NOTE:  Notify BioTel as soon as possible when encountering serious or critical trauma patients.  BioTel can then advise the receiving Trauma Center to prepare for the patient’s arrival.

Basic Level

  1. Assess and support ABCs while controlling the cervical spine.  If the initial survey is abnormal, minimize scene time.  Continue this treatment guideline en route.
  2. Initiate SPINAL MOTION RESTRICTION, as indicated.  If no spinal injury suspected, place the patient in a position of comfort.
  3. If there is evidence of shock, place the patient supine with the feet elevated and closely monitor airway status.  Treat shock according to the SHOCK Guidelines.
  4. Administer oxygen, as needed, to maintain a SpO2 of at least 94%.
  5. Control any obvious external hemorrhage.  Initiate basic care for specific injuries (ALL PATIENTS):
    1. Open abdominal wound: Saline soaked dressing, cover with waterproof material, maintain body heat
    2. Open, “sucking” chest wound: Seal with an occlusive dressing on three sides
    3. Hyperthermia: Place the patient in a cool environment; place cold packs at the head, neck, axillae, and groin
    4. Hypothermia: Protect patient from further cooling
    5. Flail chest: Closely monitor the respiratory status
    6. Stable fractures: Splint as they lie, if not grossly angulated – Do NOT use traction splints for patients under 14 years of age
    7. Impaled objects: Use bulky dressings to stabilize and secure the object
  1. Begin transport as soon as possible.

Advanced Level

  1. When traumatic brain injury is suspected:
    1. Attempt to maintain an ETCO2 reading between 35 mmHg and 40 mmHg, if assisting ventilation.
    2. If seizures develop, administer anticonvulsants as directed in the SEIZURE Guidelines.
  2. Establish IV/IO access at a TKO rate.  If the patient is hypotensive, refer to the SHOCK Guidelines.
  3. Continuously monitor ECG, SpO2 and ETCO2.
  1. If Tension Pneumothorax is suspected (Pneumothorax with Hypotension and Shock):

Adult

Pediatric

  1. For additional patient care considerations not covered under standing orders, consult BioTel.
  2. For adult and pediatric trauma destination criteria, refer to the DESTINATION Policy and to the TRAUMA TRIAGE Guidelines on the next two pages.

NOTE:  Hospital capabilities change. Paramedics are advised to contact BioTel or to consult the current version of BioTel Hospital Capabilities Matrix for updated receiving hospital/Trauma Center capabilities.


Trauma Center Criteria: Adult

Age 14 years and older: Patients meeting Major Trauma Criteria listed below should be transported to the closest Level I or Level II ADULT Trauma Center.  These centers include:

    1. Parkland Hospital (LEVEL I)
    2. Baylor University Medical Center (LEVEL I)
    3. Methodist Dallas Medical Center (LEVEL II)
    4. Medical Center of Plano (LEVEL II) – this facility can receive all trauma patients, EXCEPT:
      1. Pediatric patients under 14 years of age;
      2. Neurotrauma under 18 years of age;
      3. Penetrating eye injuries;
      4. Amputations requiring re-implantation;
      5. Burns.
      6. NOTE: Medical Center of Plano will arrange transfer, if indicated, of any patient with any of the above criteria who might be transported to this facility.

Trauma patients meeting ANY of these criteria shall be transported to either a Level I or a Level II Accredited Trauma Center

  1. Airway:
    1. Endotracheal intubation/advanced airway placement or attempted placement prior to arrival
  2. Breathing:
    1. Respiratory compromise (obstruction, use of accessory muscles/respiratory distress or inhalation injury)
    2. Respiratory rate less than 10 or greater than 29
  3. Circulation:
      1. Post-traumatic cardiac arrest
      2. Heart rate less than 50 or greater than 140
      3. Systolic BP less than 90 (adult)
  4. Disability:
      1. GCS 10 or less secondary to trauma
      2. Decreasing level of consciousness
  5. Event:
    1. Gunshot wound to head, neck or torso
    2. Evisceration
    3. Amputation proximal to the wrist or ankle
    4. Age at least 60 years PLUS ANY Level-II criteria
    5. Viable fetus (estimated at least 24 weeks gestational age) PLUS ANY Level-II criteria
    6. Burn greater than 20% TBSA (Burn greater than 10% should be transported to Parkland, if possible)
    7. Burn greater than 10% TBSA PLUS any other traumatic injury (Transport to Parkland, if possible)
    8. Use of blood products for resuscitation at transferring facility or during transport
    9. “Hot offload”
    10. Emergency Department or Medical Control Physician discretion

Level II Trauma Center Criteria:

  1. High-energy mechanism within 72 Hours prior to presentation:
    1. Fall at least 20 feet (2 stories or greater)
    2. Drowning
    3. Hanging
    4. Non-superficial penetrating injury AT or PROXIMAL TO the knee or elbow
    5. Pedestrian hit by automobile WITH ANY identified injury
    6. Bicyclist hit by automobile WITH ANY identified injury
    7. Motorcycle crash at least 20 MPH WITH ANY identified injury
    8. High-risk Motor Vehicle Crash (MVC), such as: significant intrusion or ejection or death in the same passenger compartment
  2. Anatomic:
    1. Traumatic brain injury and:
      1. GCS 11-13 secondary to trauma, OR
      2. GCS at least 14 with more than 2 organ system injuries
    2. Multiple (2 or more) long-bone fractures
    3. Pelvic fracture (excluding ground-level fall)
    4. Mangled, crushed or degloved extremity proximal to the wrist or ankle
    5. Pulseless extremity
    6. Suspected compartment syndrome
    7. Suspected spinal cord injury or spine fracture with motor deficit
    8. Age at least 60 years PLUS ANY significant trauma (excluding ground-level fall)
    9. Burns – refer to the Burn Center Criteria below
    10. Transfer with known intracranial hemorrhage and GCS at least 10
    11. Emergency Department or Medical Control Physician discretion

Burn Center Criteria – Patients with any of the following criteria should be transported directly to Parkland Hospital, if possible (refer to the BURNS Treatment Guideline):

Prehospital Trauma Triage Criteria – Pediatric: **Refer to the Children’s Medical Center’s Trauma Activation Criteria below**

Age 0 to 13 years (up to 14th birthday): Patients should be transported to Children’s Medical Center Dallas.

Age 14 years and older: Patients meeting Trauma Center Criteria should be transported to the closest Level I or Level II ADULT Trauma Center. These Centers include:

    1. Parkland Hospital (LEVEL I)
    2. Baylor University Medical Center (LEVEL I)
    3. Methodist Dallas Medical Center (LEVEL II)
    4. Medical Center of Plano* (LEVEL II) – this facility can receive all trauma patients, EXCEPT:
      1. Pediatric patients under 14 years of age;
      2. Neurotrauma under 18 years of age;
      3. Penetrating eye injuries;
      4. Amputations requiring re-implantation;
      5. Burns.
      6. NOTE: Medical Center of Plano will arrange transfer, if indicated, of any patient with any of the above criteria who might be transported to this facility.