TRAUMA DESIGNATION
Determining how (air or ground) and where (local or El Paso) to transport is an important consideration. It is still the responsibility of the first responding, highest level, EMT to make the determination if it is in the patient’s best interest to have a helicopter launched for scene response or if ground transport to the Level 3 Trauma Center (Mountain View) is the most appropriate. Time is of the essence. Helicopter transport takes considerable time commonly and may be best reserved for patients who have had the opportunity for stabilization at the Level 3 center. Mountain View’s capabilities may change in the future and a call to them for “Trauma Activation” would reveal if the patient in question would be acceptable to them.
PHYSIOLOGIC CRITERIA ("Level 1")
Consider transport to Level 1 or 2 Trauma center if ANY of the following are present:
1. Glasgow Coma Scale ≤13
2. SBP < 90mmHg
3. Breathing <10 or >29 breaths/min (<20 breaths/min if <1 year old)
4. Requires assisted ventilations
5. Shock index (Heart rate divided by systolic blood pressure) 1.0 or greater.
ANATOMIC CRITERIA ("Level 1")
Consider transport to Level 1 or 2 Trauma center if ANY of the following are present:
1. Penetrating injury to head, neck, torso, or extremity proximal to elbow or knee
2. Chest wall instability or deformity (e.g. flail chest)
3. 2 or more proximal long-bone fractures
4. Crushed, degloved, mangled, or pulseless extremity
5. Amputation proximal to wrist or ankle
6. Pelvic fractures
7. Open or depressed skull fracture
8. Paralysis
MECHANISM OF INJURY CRITERIA ("Level 2")
Consider transport to any level Trauma center if ANY of the following are present and NONE of the PHYSIOLOGIC or ANATOMIC criteria are present:
1. Falls >20 ft. (>10 feet or 2-3x height for children)
2. High Risk Auto Crash-Intrusion, including roof > 12 inches at occupant site or
>18 inches anywhere
3. Ejection (partial or complete) from automobile-Death in same compartment
4. Auto vs. pedestrian/bicyclist thrown, run over, or with significant (>20 mph) impact
5. Motorcycle crash >20 mph
SPECIAL CONSIDERATIONS/PROVIDER JUDGEMENT
Consider transport to appropriate Trauma center if ANY of the following are present:
1. Older Adults
2. Anticoagulants and bleeding disorders
3. Pregnant patients >20 week gestation
4.
SPECIAL NOTES
If the ETA of the helicopter is greater than the ground transport to the Level 3 center, consider ground transport if that is in the patient’s best interest. If the time difference is insignificant and the patient is clearly a Level 1 or 2 patient, consider helicopter response.
The decision of the first on scene EMT with the highest-level license should stand and not be countermanded by later arriving EMTs from the fire department or ambulance service except by mutual agreement. If conflict arises consider consulting on-line medical direction from the Level 3 center.
All Level 3 patients can go to Mountain View and if necessary, because of patient volume at Mountain View, to MMC (Level 4 center). As of 2024 Three Crosses Regional Hospital does not accept pregnant patients over 20 weeks gestation for any reason.
Determining how (air or ground) and where (local or El Paso) to transport is an important consideration. It is still the responsibility of the first responding, highest level, EMT to make the determination if it is in the patient’s best interest to have a helicopter launched for scene response or if ground transport to the Level 3 Trauma Center (Mountain View) is the most appropriate. Time is of the essence. Helicopter transport takes considerable time commonly and may be best reserved for patients who have had the opportunity for stabilization at the Level 3 center. Mountain View’s capabilities may change in the future and a call to them for “Trauma Activation” would reveal if the patient in question would be acceptable to them.
PHYSIOLOGIC CRITERIA ("Level 1")
Consider transport to Level 1 or 2 Trauma center if ANY of the following are present:
1. Glasgow Coma Scale ≤13
2. SBP < 90mmHg
3. Breathing <10 or >29 breaths/min (<20 breaths/min if <1 year old)
4. Requires assisted ventilations
5. Shock index (Heart rate divided by systolic blood pressure) 1.0 or greater.
ANATOMIC CRITERIA ("Level 1")
Consider transport to Level 1 or 2 Trauma center if ANY of the following are present:
1. Penetrating injury to head, neck, torso, or extremity proximal to elbow or knee
2. Chest wall instability or deformity (e.g. flail chest)
3. 2 or more proximal long-bone fractures
4. Crushed, degloved, mangled, or pulseless extremity
5. Amputation proximal to wrist or ankle
6. Pelvic fractures
7. Open or depressed skull fracture
8. Paralysis
MECHANISM OF INJURY CRITERIA ("Level 2")
Consider transport to any level Trauma center if ANY of the following are present and NONE of the PHYSIOLOGIC or ANATOMIC criteria are present:
1. Falls >20 ft. (>10 feet or 2-3x height for children)
2. High Risk Auto Crash-Intrusion, including roof > 12 inches at occupant site or
>18 inches anywhere
3. Ejection (partial or complete) from automobile-Death in same compartment
4. Auto vs. pedestrian/bicyclist thrown, run over, or with significant (>20 mph) impact
5. Motorcycle crash >20 mph
SPECIAL CONSIDERATIONS/PROVIDER JUDGEMENT
Consider transport to appropriate Trauma center if ANY of the following are present:
1. Older Adults
2. Anticoagulants and bleeding disorders
3. Pregnant patients >20 week gestation
4.
SPECIAL NOTES
If the ETA of the helicopter is greater than the ground transport to the Level 3 center, consider ground transport if that is in the patient’s best interest. If the time difference is insignificant and the patient is clearly a Level 1 or 2 patient, consider helicopter response.
The decision of the first on scene EMT with the highest-level license should stand and not be countermanded by later arriving EMTs from the fire department or ambulance service except by mutual agreement. If conflict arises consider consulting on-line medical direction from the Level 3 center.
All Level 3 patients can go to Mountain View and if necessary, because of patient volume at Mountain View, to MMC (Level 4 center). As of 2024 Three Crosses Regional Hospital does not accept pregnant patients over 20 weeks gestation for any reason.