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Guidelines for Field Triage of Injured Patients: In conjunction with the Morbidity and Mortality Weekly Report published by the Center for Disease Control and Prevention.

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TLDR
The methodology, findings and updated guidelines from the Morbidity & Mortality Weekly Report (MMWR) from the 2011 Panel are presented along with commentary on the burden of injury in the U.S., and the role emergency physicians have in impacting morbidity and mortality at the population level.
Abstract
The Centers for Disease Control and Prevention (CDC) has published significant data and trends related to the national public health burden associated with trauma and injury. In the United States (U.S.), injury is the leading cause of death for persons aged 1–44 years. In 2008, approximately 30 million injuries resulted in an emergency department (ED) evaluation; 5.4 million (18%) of these patients were transported by Emergency Medical Services (EMS).1 EMS providers determine the severity of injury and begin initial management at the scene. The decisions to transport injured patients to the appropriate hospital are made through a process known as “field triage.” Since 1986, the American College of Surgeons Committee on Trauma (ACS-COT) has provided guidance for the field triage process though its “Field Triage Decision Scheme.” In 2005, the CDC, with financial support from the National Highway Traffic Safety Administration (NHTSA), collaborated with ASC-COT to convene the initial meeting of the National Expert Panel on Field Triage (the Panel) to revise the decision scheme. This revised version was published in 2006 by ASC-COT, and in 2009 the CDC published a detailed description of the scientific rational for revising the field triage criteria entitled, “Guidelines for Field Triage of Injured Patients.”2–3 In 2011, the CDC reconvened the Panel to review the 2006 Guidelines and recommend any needed changes. We present the methodology, findings and updated guidelines from the Morbidity & Mortality Weekly Report (MMWR) from the 2011 Panel along with commentary on the burden of injury in the U.S., and the role emergency physicians have in impacting morbidity and mortality at the population level.

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Journal ArticleDOI

Physiologic, demographic and mechanistic factors predicting New Injury Severity Score (NISS) in motor vehicle accident victims.

TL;DR: This study demonstrated that injury severity (NISS) was concurrently and independently predicted by poor pre-hospital physiologic status, increasing age and female gender, and several mechanistic measures of localised and generalised trauma energy.
Journal ArticleDOI

Comorbidities, anticoagulants, and geriatric-specific physiology for the field triage of injured older adults.

TL;DR: The utility of comorbidities, anticoagulant use, and geriatric-specific physiologic measures to improve the sensitivity of the field triage guidelines for high-risk older adults in the out-of-hospital setting is evaluated.
Journal ArticleDOI

Effect of the 2011 Revisions to the Field Triage Guidelines on Under- and Over-Triage Rates for Pediatric Trauma Patients

TL;DR: Use of the 2011 Field Triage Guidelines for children resulted in an unacceptably high rate of under-triage regardless of the version used, and research is needed to determine how to better assist EMS providers in identifying children who need the resources of a trauma center.
Journal ArticleDOI

Validation of prehospital trauma triage criteria for motor vehicle collisions.

TL;DR: Vehicular crash data could improve the ability of emergency medical service providers to triage injured occupants and older patients (age > 55 years) who met Step 3 mechanism criteria had higher predictive values for injury for nearly all crash characteristics.
Journal ArticleDOI

Identification of dynamic prehospital changes with continuous vital signs acquisition.

TL;DR: Real-time continuous vital signs monitoring and data acquisition can identify dynamic prehospital changes, which may be missed compared with vital signs recorded manually during distinct prehospital intervals.
References
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Journal ArticleDOI

A National Evaluation of the Effect of Trauma-Center Care on Mortality

TL;DR: It is shown that the risk of death is significantly lower when care is provided in a trauma center than in a non-trauma center and argue for continued efforts at regionalization.
Journal Article

Guidelines for field triage of injured patients recommendations of the national expert panel on field triage.

TL;DR: In this paper, the authors present the dissemination and impact of the 2006 Guidelines for field triage of injured patients; outlines the methodology used by the Panel for its 2011 review; explains the revisions and modifications to the physiologic, anatomic, mechanism-of-injury, and special considerations criteria; and provides the rationale used by Panel for these changes.
Journal ArticleDOI

Access to trauma centers in the United States.

TL;DR: Selecting trauma centers based on geographic need, appropriately locating medical helicopter bases, and establishing formal agreements for sharing trauma care resources across states should be considered to improve access to trauma care in the United States.
Journal ArticleDOI

The effect of trauma center designation and trauma volume on outcome in specific severe injuries

TL;DR: Level I trauma centers have better outcomes than lower-level centers in patients with specific injuries associated with high mortality and poor functional outcomes, and the volume of major trauma admissions does not influence outcome in either level I or II centers.
Journal ArticleDOI

Outcome of Hospitalized Injured Patients After Institution of a Trauma System in an Urban Area

TL;DR: Establishment of a trauma system shifted the more seriously injured patients to level I trauma centers, where there was a significant reduction in the adjusted death rate.
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