Trauma

TRIAGE CRITERIA AT RHODE ISLAND HOSPITAL

Code Yellow LEVEL A  (Level B Team + Trauma Attending)

	Scene / ED Presentation	Transfer from Outside Hospital
Physiologic / Anatomic Criteria
AIRWAY / BREATHING	Respiratory Compromise or ObstructionIntubation in the field /EDMaxillofacial injuries compromising airway	Respiratory compromise or are in need of emergent airwayIntubated trauma transfers
CIRCULATION	Systolic blood pressure  < 90 at any time	Systolic blood pressure  < 90 at any time, receiving blood products to maintain vital  signs
CENTRAL NERVOUS SYSTEM/HEAD	GCS 3-8* Spinal cord injury/paralysis	GCS 3-8 as determined by sending physician*
EXTREMITIES / SKELETAL	Amputation proximal to wrist or ankleExtremity trauma with neurovascular deficit as demonstrated by abnormal ABI or absence of signals (i.e. Threatened Limb)
Mechanism Criteria / Other
BURNS	>40% TBSA second and third degree combinedHigh voltage electrical injury >600 volts
HYPOTHERMIA / EXPOSURE	<32°C or <90°F with cardiac arrest
GUNSHOT WOUND	GSW to head, neck, chest, abdomen, or extremities proximal to the      elbow/knee (T-shirt and boxer short distribution – mid-thigh to mid-arm)
OTHER	ED Attending or ED nurse’s discretion.

Code Yellow LEVEL B  (Level B Team)

	Scene / ED Presentation	Transfer from Outside Hospital
Physiology / Anatomy / Injury Criteria
CIRCULATION	Uncontrolled hemorrhage
CENTRAL NERVOUS SYSTEM / HEAD / SPINE	GCS 9-12* Open or depressed skull fracture	GCS 9-12 as determined by sending physician*Basilar skull fracture
CHEST	Chest wall deformity	Chest wall deformity, pulmonary contusion, traumatic pneumothorax/ hemothorax
ABDOMEN	Crush injury (industrial accident, pinned by car, etc.) with physical exam findings
PREGNANCY	Fundus at the umbilicus AND meets Level B or Level C criteria
EXTREMITIES / SKELETAL	Proximal long bone fractures in multiple limbs (humerus and femur)Unstable pelvis
Mechanisms  (Occult Injury)
FALL	Fall  >15 feet
PENETRATING WOUND (Non-GSW)	Head, neck, chest, abdomen, pelvis, groin, and back (T-shirt and boxer short  distribution – mid-thigh to mid-arm)
BURNS	Singed facial or nasal hairBurn in enclosed spaceBurn ≥20% TBSA
FROSTBITE	Presents with frozen tissue or <24 hours of rewarming
HYPOTHERMIA / EXPOSURE	<32°C or <90°F

Code Yellow LEVEL C  (Level C Team)

	Scene / ED Presentation	Transfer from Outside Hospital
Anatomy
CENTRAL NERVOUS SYSTEM / HEAD	GCS 13-14*	GCS 13-14 as determined by sending physician*
NECK / CHEST / ABDOMEN	Seatbelt marks with no other Level A or B CriteriaBlunt injury with chest, abdominal or pelvic pain or tenderness
PREGNANCY	Fundus below the umbilicus and meets Level C criteria
OPEN LONG BONE FXS	Any mechanism
Mechanisms  (Occult Injury)
FALLS	Age >65 yr. on home anticoagulants or antiplatelet therapy (excludes ASA)
MVC	High risk crash Partial or complete ejectionIntrusion >12” occupant site; >18” any siteDeath in same passenger compartment
BURNS	>10 TBSA second and third degree<10% TBSA with circumferential burns>1% TBSA to face, hands, feet, or perineum