Identification of Potential Major Trauma

 Vital signs

The first step to identifying the presence of potential major trauma (pMT) is to assess the vital signs. In the pre-hospital setting, potential major trauma is identified according to the following criteria4 5.

 
MAJOR TRAUMA CRITERIA VITAL SIGNS
AGETerm – 3 Months4-11 Months1-4 Years5-11 Years12 -15 Years 16 Years & over
HR<100 or >180<100 or >180<90 or >160<80 or >140<60 or >130<60 or > 120
RR>60>50>40>30>30< 10 or > 30
BP sys<50<60<70<80<90< 90
SpO2<90%<90%<90%<90%<90%<90%
GCS< 15< 15< 15< 15< 15< 13

If the patient has any one of the above signs present, then pMT is identified. The patient must be assessed for any life-threatening injuries that can be immediately managed in the field and consideration of transport to an MTS must be commenced.

 Injuries found or suspected

The presence of any one of the following assumed or actual anatomic injuries constitutes pMT for the purpose of primary triage6.

All penetrating injuries

  • Excludes isolated superficial limb injuries

Blunt injuries

  • Significant injury to a single region such that specialised care or intervention may be required, or that life, limb or long-term quality of life may be at risk
  • Significant injuries involving more than one body region

Specific injuries

  • Limb amputations or limb-threatening injuries
  • Suspected spinal fracture and/or spinal cord injury
  • Burns to 20% or more of the body for an adult, 10% or more for a child, or suspected respiratory tract burns
  • High-voltage burn injuries
  • Serious crush injury
  • Major open fracture or open dislocation
  • Fracture to two or more of the femur, tibia or humerus
  • Suspected fractured pelvis

Isolated head injury in older people

Where a person has an isolated head injury with an altered conscious state (GCS < 13) and is over 65 years of age and has sustained their injury as a result of a low fall (< 1 m) and is located in the metropolitan region then the patient should be transported to the nearest metropolitan neurosurgical service (MNS) or MTS. Data from the Victorian trauma system demonstrates that outcomes for this subset are comparable when care is delivered in an MNS as when provided in an MTS7.

 High-risk criteria

The triage of trauma patients who are physiologically stable and where only a single mechanistic criterion is present has a high potential for over-triage. The Victorian pre-hospital high-risk criteria requires both a specific trauma mechanism and either an age or comorbidity element present in order to identify as pMT8.

Specific trauma mechanism

  • Ejection from vehicle
  • Motor/cyclist impact > 30kph
  • Struck on the head by object falling > 3m
  • Explosion
  • High-speed car accident > 60kph
  • Pedestrian impact
  • Prolonged extrication
  • Fall from heigh > 3m

AND

Additional patient criteria

  • Age > 55 or a child < 16

or

  • Pregnant

or

  • Significant comorbidity to include one or more of:
diabetes, epilepsy, cardiac failure, angina, acute myocardial infarction (AMI), obesity, chronic respiratory disease, chronic renal failure, symptomatic chronic obstructive airway disease (COAD), renal or liver failure, chronic liver disease or congenital coagulopathy.

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