Protocol 2-451-50 - General Trauma Management - TRAUMA Destination Matrix

CMH EMS & MIH Protocols

These guidelines have been adopted from the work of the 2021 National Guidelines for the Field Triage of Injured Patients or “Guidelines”. A multidisciplinary expert panel led by the American College of Surgeons (ACS) undertook this revision with support from the National Highway Traffic Safety Administration (NHTSA), the Health Resources and Services Administration’s (HRSA) Maternal and Child Health Bureau, and EMS for Children Program.

In consideration of the ACS National Guideline for the Field Triage of Injured Patients the following destination matrix has been set forth.

• These are guidelines only. Scene or patient conditions may influence an alternate destination determination.
• Patients have the right to refuse transport to the recommended destination. If the patient refuses recommended destination, document "transport / refused care" and have patient sign refusal.
• When initial transport from the scene would be prolonged, the patient may be transported to the nearest appropriate facility.

Yellow Criteria: Moderate Risk for Serious Injury

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)

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 (eg, motorcycle, ATV, horse, etc.)
• Pedestrian/bicycle rider thrown, run over, or with significant impact
• Fall from height > 10 feet (all ages)

EMS Judgement

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
• Special, high-resource healthcare needs
• Pregnancy > 20 weeks
• Burns in conjunction with trauma
• Children should be triaged preferentially to pediatric capable centers
• If concerned, take to trauma center

Red Criteria: High Risk for Serious Injury

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

Injury patterns

• Penetrating injuries to head, neck, torso and proximal extremities
• Skull deformity, suspected skull fracture
• 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 Sings

All Patients

• Unable to follow commans (motor GCS < 6)
• RR < 10 or > 29 breaths/min
• Respiratory distress or need for respiratory support
• Room-air pulse oximitry < 90%

Age 0-9 years

• SBP < 70 mmHg + (@ x age in years)

Age 10-64 years

• SBP < 90 mmHg or
• HR > SBP

Age ≥65 years

• SBP < 110 mmHg or
• HR > SBP

CMH Pre-Hospital Services Mission: "Provide safe, exceptional, and compassionate care to our communities with an emphasis on highly trained and empowered staff."

CMH Mobile Integrated Healthcare Mission: "Provide exceptional, compassionate, and patient-centered care by a mobile collaborative team to improve patient experience, improve quality outcomes, and reduce healthcare costs."

Polk, Hickory, Cedar, & St Clair County EMS Protocols is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.