Access Vital Signs / level of consciousness
Glasgow Coma Scale <14
Systolic BP <90
Respiratory rate <10 or >29 or equal too
<20 for infant <1 year , or need for ventilatory support.
PEDS Abnormal Appearance &/or Abnormal Work of Breathing &/or Abnormal Circulation
Assess anatomy of injury
- All penetrating injuries to head,neck,torso, or extremities proximal of elbow or knee.
- Chest wall instability or deformity
- Two or more proximal long bone fractures
- Crush injury , degloved , or mangled, pulseless extremely
- Amputation proximal to wrist or ankle
- Pelvic fractures
- Open or depressed skull fractures
- Paralysis
- Neurologic / vascular defect of extremity
- Tourniquet applies to traumatic injury
Assess mechanism of injury
- Fall >3 times patients height or >or equal too 15 feet
- Auto vs Pedestrian/ Bicyclist thrown, run over , or with significant (> or equal too 20 MPH) impact
- Motorcycle crash > or equal too 20 MPH
- Exposure to blast or explosion
- Combination trauma with burns
Assess mechanism of injury
High Risk Auto Crash
• Intrusion, including roof
> or equal too 12 Inches , > or equal too 18 inches any site
• Ejection (partial or complete) from vehicle
• Death in same passenger compartment
• Vehicle telemetry data consistent with high risk injury
• Vehicle rollover with unrestrained patient
Assess special considerations
• Age <5 or > or equal too 55
• Low impact mechanism
(ex ground level fall) > or equal too 65 Years old
• Bleeding disorder
• Anticoagulant or antiplatelet therapy (exempt ASA)
• Pregnancy > or equal too 20 weeks
• Poor Baseline physiologic reserve
(Severe cardiac and/or respiratory disease)
• Extrication time > or equal too 20 minutes
• EMS provider judgement
