table 13-1 rapid triage and transport guidelines

PRIMARY INTERVENTIONS AND ADJUNCTS TO BE CONSIDER

SURVEY FINDING PERFORMED AT LOCAL FACILITY TRANSFER?

Airway Airway compromise Intubate, end-tidal CO2, pulse oximeter, EKG, Y

chest x-ray

High risk for airway loss Monitor EKG, pulse oximeter, ABG Y

Breathing Tension pneumothorax Needle, finger, chest tube Y

Hemothorax, open pneumothorax Chest x-ray, chest tube Y

Hypoxia/hypoventilation Intubate Y

Circulation Hypotension Reliable IV/IO access, warm IV fluids, control Y

external hemorrhage using pressure, topical
hemostatics, or tourniquets

Pelvic fracture Pelvic x-ray, pelvic binder, or sheet Y

Vascular injury (hard signs, such Reliable IV/IO access, warm IV fluids, control Y
as expanding hematoma and external hemorrhage using pressure, topical
active bleeding) hemostatics, or tourniquets

Open fracture Reduce and splint and dress Y

Abdominal distention/peritonitis FASTa Y

Disability GCS < 13 Intubate when GCS < 9b Y

Intoxicated patient who cannot Sedate, intubate Y

be evaluated

Evidence of paralysis Restrict spinal motion; monitor for neurogenic shock Y

Exposure Severe hypothermia External warming Y

SECONDARY INTERVENTIONS AND ADJUNCTS TO BE CONSIDER

SURVEY FINDING PERFORMED AT LOCAL FACILITY TRANSFER?

Head and Depressed skull fracture or CT scanc Y

Skull penetrating injury

Maxillofacial Eye injury, open fractures, CT scanc Y

complex laceration, ongoing
nasopharyngeal bleeding

Note: Evaluate and make the decision to transfer within first 15–30 minutes of trauma team leader arrival.
a. Perform only if it affects the decision to transfer.
b. Patients with GCS scores 9–13 may require intubation, depending on clinical circumstances and discussion with accepting doctor.
c. Perform only in hemodynamically stable patients for whom the results will affect the decision to transfer or the care provided before transfer.

Continued
table 13-1 rapid triage and transport guidelines (continued)

SECONDARY INTERVENTIONS AND ADJUNCTS TO CONSIDER

SURVEY FINDING BE PERFORMED AT LOCAL FACILITY TRANSFER?

Neck Hematoma, crepitus, midline CT scanc Y

tenderness or deformity

c
Chest Multiple rib fractures, flail chest, CXR, FAST , CT scanc Y
pulmonary contusion, widened
mediastinum, mediastinal air

a
Abdomen Rebound, guarding FAST, DPL , CT scanc Y

Perineum/ Laceration Proctosigmoidoscopyc, speculum Y

Rectum/Vagina examinationc

Neurologic Deficit Plain filmsc, CT scanc, MRIc Y

Musculoskeletal Complex or multiple fractures or Extremity xraysc, spine xraysc, or CT scanc Y

dislocations or bony spine injuries

Other Factors Age, multiple comorbidities,

pregnancy, burn

Note: Evaluate and make the decision to transfer within first 15–30 minutes of trauma team leader arrival.
a. Perform only if it affects the decision to transfer.
b. Patients with GCS scores 9–13 may require intubation, depending on clinical circumstances and discussion with accepting doctor.
c. Perform only in hemodynamically stable patients for whom the results will affect the decision to transfer or the care provided before transfer.