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 criteria.5, 6. | MAJOR TRAUMA CRITERIA VITAL SIGNS | ||||||
| AGE | Term – 3 Months | 4-11 Months | 1-4 Years | 5-11 Years | 12 -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 |
Potential major trauma is identified if the patient has any one of the above vital signs present. This patient must be further assessed for any life-threatening injuries that can be immediately managed in the field and planning 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 triage: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
- Spinal cord injury or suspected spinal fracture
- Burns to 20% or more of the body for an adult or 10% or more for a paediatric (≤15 years)
- Suspected respiratory tract burns
- High-voltage burn injuries (>1000 volts)
- 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
A person aged 65 years and over with an isolated head injury and presenting with a GCS less than 13, who 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 or MTS. Data from the Victorian State Trauma Registry (VSTR) demonstrates that outcomes for this subset are comparable when care is delivered in an metropolitan neurological service as when provided in an MTS. 7.
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
- Motor/cyclist impact > 30 kph
- High-speed car accident > 60 kph
- Pedestrian impact
- Prolonged extrication
- Ejection from vehicle
- Explosion
- Struck on the head by object falling > 3 m
- Fall from height > 3 m
AND
Additional patient criteria
- Age < 12 or > 55
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 pulmonary disease (COPD), renal or liver failure, chronic liver disease or coagulopathy of any origin.