A recent study published by the Oregon Health & Science University indicates that during a three-year period in seven metropolitan areas in the western U.S., the emergency medical services system sent more than 85,000 minimally injured people to trauma centers, costing the health system more than $130 million a year.

There should be little argument that our healthcare system has never been more in flux and drastic changes are either upon us or very close by. I suggest that pre-hospital providers evaluate the current trauma system entry criteria and propose changes that may help to cut down on this expensive over-triage issue. Who better to point out where the current system is causing us to enter patients that really don’t need the services of a trauma center, than the personnel using the criteria.

Take a look at the existing criteria below (taken from ORS 431.607 and effective 1/1/2013), and tell me which ones you suggest need to be modified. Be specific. Let’s put together a list of suggestions from the collective minds reading this. Along with additional study data that looks at trauma system entry criteria and ultimate patient disposition, we should be able to modify the criteria based upon sound science and professional experience for the policy makers to consider. If we don’t take the initiative, we will be forced to live with whatever changes come from other sources. Being proactive is in everyone’s best interests, including the patient’s.

MANDATORY TRAUMA CRITERIA

Vital Signs & Level of Consciousness
• Systolic blood pressure • Respiratory distress with rate 29 ( • Need for ventilatory support; or
• Glasgow Coma Scale < 13

Anatomy of Injury
• All penetrating injuries to head, neck, torso, and extremities proximal to elbow or knee; or
• Chest wall instability or deformity (e.g., flail chest); or
• Two or more proximal long-bone fractures; or
• Crushed, degloved, mangled, or pulseless extremity; or
• Amputation proximal to wrist or ankle; or
• Suspected pelvic fractures; or
• Open or depressed skull fracture; or
• Motor sensory deficit

Mechanism of Injury
• Falls – Adults: > 20 ft. (one story is equal to 10 ft.); or Children: > 10 ft. or 2-3 times the height of the child; or
• High-Risk Auto Crash

  • Intrusion, including roof: > 12 in. occupant site; > 18 in. any site; or
  • Ejection (partial or complete) from automobile; or
  • Death in same passenger compartment; or
  • Vehicle telemetry data consistent with high risk of injury; or

• Auto vs. pedestrian/bicyclist thrown, run over, or with significant (> 20 mph) impact; or
• Motorcycle or ATV crash > 20 mph

Special Patient or System Considerations
• Older adults – Risk of injury/death increases after age 55 years; or SBP 20 Weeks; or
• EMS provider judgment