Variation in Prehospital Trauma Triage Protocols.

OBJECTIVES

Trauma patients are a high volume and morbidity population, showing the importance of their prehospital care. This study aimed to evaluate the current status and consistency of prehospital trauma triage protocols in the United States.

METHODS

States with statewide emergency medical services (EMS) protocols and trauma triage criteria were included. For each state, EMS protocols were analyzed to assess trauma centers and categories, trauma triage criteria (including physiologic, anatomic, mechanism, and patient factors), and transport mode and destination guidance.

RESULTS

Of 31 states with statewide EMS protocols, 29 (94%) included prehospital trauma triage criteria. States most commonly had two (15 (52%) states) or four (nine (31%) states) trauma categories identified with colors, numbers, or letters. Systolic blood pressure (29 (100%) states), Glasgow Coma Scale (15 (52%) states), and respiratory rate (29 (100%) states) were the most frequently used physiologic criteria. Anatomic criteria included central penetrating trauma (29 (100%) states), bilateral femur fractures (26 (90%) states), open skull fractures (25 (86%) states), bilateral extremity paralysis (28 (97%) states), amputation above the wrist/ankle (28 (97%) states), unstable pelvic fracture (27 (93%) states), and flail chest (27 (93%) states). Death from the same mechanism (27 (93%) states), ejection (28 (96%) states), or pedestrian/bike versus automobile (29 (100%)) were mechanistic criteria for motor vehicle accidents. Patient factors, including age, anticoagulation, and pregnancy were patient factors used as trauma criteria. Destination differed by trauma category in 22 (76%) states, and helicopter transport was advised for drive times exceeding thresholds ranging from ten to sixty minutes.

CONCLUSIONS

In this national study of EMS protocols, we found heterogeneity in the structure and indications used for prehospital trauma triage criteria. This study highlights the need for standardization to ensure trauma patients receive timely and appropriate care.