It is vital that patients suffering from a major trauma are identified early so they can be triaged to an appropriate level of care in a timely manner. This is essential in order to reduce preventable death and permanent disability.

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 pMT⁽⁸⁾.

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

Pregnant

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.

Major Trauma Guidelines & Education – Victorian State Trauma System