Guidelines for the Field Triage of Injured Patients, CDC USA

Injuries affect all Americans.

They are the leading cause of death for children and adults from age 1 to 44 in the United States.

At the scene of an injury, Emergency Medical Service (EMS) professionals must identify the severity and type of injury, and determine which hospital or other facility would be the most appropriate to meet the needs of the patient. This is done through a process called “field triage.”

The profound importance of daily on-scene triage decisions made by EMS professionals is reinforced by CDC-supported research that shows that the overall risk of death was 25 percent lower when care was provided at a Level I trauma center than when it was provided at a non-trauma center.

Not all injured patients can or should be transported to a Level I trauma center. Other hospitals can effectively meet the needs of patients with less severe injuries, and may be closer to the scene. Transporting all injured patients to Level I centers—regardless of injury severity—limits the availability of Level I trauma center for those patients who really need the level of care provided at those facilities. Proper field triage ensures that patients are transported to the most appropriate healthcare facility that best matches their level of need.

In 2009, the Centers for Disease Control and Prevention (CDC) published guidance on the field triage process in “Guidelines for Field Triage of Injured Patients, Recommendations of the National Expert Panel on Field Triage” in the Morbidity and Mortality Weekly Report (MMWR).

he updated Guidelines, published in the newly released MMWR reflect the results of the Panel’s deliberations and include changes made upon the best available evidence, and incorporate the experiential base that CDC has developed through its close work with states, national organizations, communities, and individual professionals.

The 2011 Guidelines for the Field Triage of the Injured Patient initiative is developed to give EMS leaders and professionals the tools they need to implement and adopt the 2011 Guidelines.

Link CDC Injury Prevention & Control: Field Triage

Guidelines for Field Triage of Injured Patients Recommendations of the National Expert Panel on Field Triage 2021

https://emssolutionsint.blogspot.com/2022/10/trauma-systems-national-guidelines-for.html

Guidelines for the Field Triage of Injured Patients. CDC

Guidelines for the Field Triage of Injured Patients

Guidelines for Field Triage of Injured Patients Recommendations of the National Expert Panel on Field Triage 2021

https://emssolutionsint.blogspot.com/2022/10/trauma-systems-national-guidelines-for.html

Field Triage

Guidelines for the Field Triage of Injured Patients

Injuries affect all Americans.
They are the leading cause of death for children and adults from age 1 to 44 in the United States.
At the scene of an injury, Emergency Medical Service (EMS) professionals must identify the severity and type of injury, and determine which hospital or other facility would be the most appropriate to meet the needs of the patient. This is done through a process called “field triage.”
The profound importance of daily on-scene triage decisions made by EMS professionals is reinforced by CDC-supported research that shows that the overall risk of death was 25 percent lower when care was provided at a Level I trauma center than when it was provided at a non-trauma center.
Not all injured patients can or should be transported to a Level I trauma center. Other hospitals can effectively meet the needs of patients with less severe injuries, and may be closer to the scene. Transporting all injured patients to Level I centers—regardless of injury severity—limits the availability of Level I trauma center for those patients who really need the level of care provided at those facilities. Proper field triage ensures that patients are transported to the most appropriate healthcare facility that best matches their level of need.
In 2009, the Centers for Disease Control and Prevention (CDC) published guidance on the field triage process in “Guidelines for Field Triage of Injured Patients, Recommendations of the National Expert Panel on Field Triage” in the Morbidity and Mortality Weekly Report (MMWR).
The updated Guidelines, published in the newly released MMWR reflect the results of the Panel’s deliberations and include changes made upon the best available evidence, and incorporate the experiential base that CDC has developed through its close work with states, national organizations, communities, and individual professionals.
The 2011 Guidelines for the Field Triage of the Injured Patient initiative is developed to give EMS leaders and professionals the tools they need to implement and adopt the 2011 Guidelines.

Link to CDC

Download the

Guidelines for the Field Triage of Injured Patients

Guidelines for Field Triage of Injured Patients Recommendations of the National Expert Panel on Field Triage 2021

Dr Ramon REYES, MD,
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TRAUMA SYSTEMS National Guidelines for the Field Triage of Injured Patients by Amercan College of Surgeons ACS. 2021

 

Es oficial, PHTLS y ATLS asumen este algoritmo de Triage Prehospitalario simplificado con solo dos colores, Amarillo (no grave) Rojo Grave, Negro (nada que hacer) Verde que se siente y tome agua en lo que trabajamos con los que nos necesitan.. .Traducción

It's official, PHTLS and ATLS assume this simplified Prehospital Triage algorithm with only two colors, Yellow (not serious) Red Serious, Black (nothing to do) Green to sit down and drink water while we work with those who need us.. . Translation

Dr. Ramon Reyes, MD jijij TRAUMA SYSTEMS National Guidelines for the Field Triage of Injured Patients by Amercan College of Surgeons ACS. 2021  

https://journals.lww.com/jtrauma/Fulltext/2022/08000/National_guideline_for_the_field_triage_of_injured.19.aspx

https://www.facs.org/quality-programs/trauma/systems/field-triage-guidelines/

Resources

The ACS, in collaboration with partner organizations, has developed a series of resources and implementation tools for use by providers and EMS and trauma system leadership.

The following manuscripts have been published describing the evidence and process for revision of the Guidelines.

• The National Trauma Triage Protocol: How EMS Perspective Can Inform the Guideline Revision
• Under-Triage and Over-Triage Using the Field Triage Guidelines for Injured Patients: A Systematic Review 
• National Guideline for the Field Triage of Injured Patients: Recommendations of the National Expert Panel on Field Triage, 2021
• Mechanism of Injury and Special Considerations as Predictive of Serious Injury: A Systematic Review

Additional resources:

• Printable Handout
• Word Document version of Guideline to be Adapted by Local Trauma and EMS Systems

Contact Information

If you have any questions, please contact traumasystems@facs.org.

The 2021 National Guidelines for the Field Triage of Injured Patients or “Guidelines” are now available. A multidisciplinary expert panel led by the American College of Surgeons (ACS) undertook this revision with support from the National Highway Traffic Safety Administration (NHTSA), the Health Resources and Services Administration’s (HRSA) Maternal and Child Health Bureau, and EMS for Children Program.

For three decades, the Guidelines have been widely adopted by trauma systems in the United States to support decision making by EMS clinicians in transport destination determinations for injured patients. The goal has been to ensure that seriously injured patients are transported to the most clinically appropriate trauma centers. 

The 2021 revision was based on a scientific literature review conducted by Oregon Health and Science University as well as the results from a broad stakeholder feedback tool, which aimed to capture the perspective from those in the field.

National Guideline for the Field Triage of Injured Patients: Recommendations of the National Expert Panel on Field Triage, 2021

Journal of Trauma Surgery

https://journals.lww.com/jtrauma/Fulltext/2022/08000/National_guideline_for_the_field_triage_of_injured.19.aspx

Training Materials

In parallel with the revision of the National Guideline for the Field Triage of Injured Patients, training materials have been developed for use in teaching field triage to new and practicing EMS professionals. Two slide sets are available: one which provides an overview of the 2021 Guideline and is intended for educators to use for the didactic portion of instruction and one that offers customizable case-based triage scenarios for discussion.

Manuscript

It is encouraged that EMS educators read the source manuscript to fully understand the Guideline and rationale for the included criteria and structure. The Guideline is intended for patient destination decision in the field, not mass casualty incidents (MCI) or trauma team activation at a receiving trauma center.

National Guideline for the Field Triage of Injured Patients: Recommendations of the National Expert Panel on Field Triage, 2021

Slide Sets

The didactic portion of instruction covers the current version of the Guideline, highlights changes from the past 2011 version, as well as the rationale for the changes made. Educators should review these slides with students first before moving into the case-based scenarios. The presentation can be customized for the local trauma system and its resources and protocols by modifying the indicated slides.

Didactic Slide Deck

Case-based triage scenarios were developed to demonstrate application of the Guideline. The slides are designed for use following the didactic portion of instruction. There are 6 total cases, some with multiple versions. Depending on time constraints, it is suggested that educators select 3-5 cases to review. Each case includes several discussion points, including the criterion demonstrated, system and resource considerations, bypass of other centers, ultimate patient destination, and transport mode considerations. There are notes for the presenter on each slide to guide the discussion. The cases have been developed in two versions.

The first version is intended for experienced EMS clinicians practicing within an established trauma system to maximize the practical application of the National Trauma Field Triage Guideline. This slide set emphasizes a discussion framing triage decision making within the context of the local EMS and trauma system in which the students practice. Two versions of these slides are available based on either an ABCD or MARCH primary survey to align with updated initial assessment in Version 2 of the NASEMSO Model EMS Clinical Guidelines. Select the version with the primary survey approach used by the students.

ABCD Slide Deck

MARCH Slide Deck

The second version is intended to be used primarily with new EMS students to help them gain an understanding of how system resources may impact their decision making. This set of slides includes a mix of urban, suburban, and rural settings with hypothetical trauma and EMS system resources for students to consider when making triage decisions. Two versions of these slides are available based on either an ABCD or MARCH primary survey. Select the version with the primary survey approach used by the students.

New EMS Clinicians ABCD Slide Deck

New EMS Clinicians MARCH Slide Deck

Dr Ramon REYES, MD,
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Empalamiento 🗡️ Lesión by @nirhusmd

by @nirhusmd

¿Qué vasos sanguíneos principales podrían verse afectados por esta lesión? ¡La anatomía importa!

Empalamiento 🗡️ Lesión

Se muestra a un pasajero masculino de 32 años involucrado en un accidente automovilístico de alta velocidad con vuelco. No llevaba puesto el cinturón de seguridad. El automóvil golpeó una cerca de tela metálica y el paciente fue atravesado con un poste de la cerca en el tórax derecho.

Parabrisas ➡️ pecho derecho del paciente ➡️ salida trasera del asiento del pasajero

Presentación ⬇️

1. Empalamiento complejo tipo 2

2. AAO X3 (despierto, alerta y orientado a persona, lugar, tiempo)

3. GCS15

4. Sin hemorragia activa (hemodinámicamente estable)

5. Radiografía de tórax = sin lesión pulmonar aguda identificable

6. Quirófano ➡️ intubado, exploración de heridas, control de hemorragias, extracción de objetos, resección de tejidos blandos desvitalizados, lavado de heridas, reaproximación de músculos, cierre del sitio quirúrgico con grapas, colocación de tubo torácico 28 French del lado derecho.

7. POST-OP ➡️ UCI

Manejo de Empalamiento ⬇️

1. Extracción cuidadosa por EMS. Mínima manipulación del objeto.

2. Transporte rápido al centro de trauma

3. NO retire ningún objeto en la escena. Dejar en su lugar.

4. Imágenes si es necesario

5. Quirófano

6. Control vascular ANTES de la extracción del objeto.

7. A menudo es necesaria la reparación de la arteria/vena subclavia

8. Resección del tejido necrótico. Preservar el tejido pulmonar para prevenir el empiema.

9. Herida contaminada = lavado, desbridamiento, antibióticos y profilaxis antitetánica 💉

10. Cierra el cofre cuando la situación lo permita

El paciente sobrevivió a la lesión y fue dado de alta a su domicilio 🙏

#Medicina de emergencia

Rescate por atrapamiento por objeto punzante

ver y compartir video en Facebook https://www.facebook.com/DrRamonReyesMD/videos/6469735356446468

posted by Dr. Ramon Reyes, MD ∞🧩 

ver: 

1. Paciente masculino sobrevive tras ser atravesado por un poste en un accidente automovilístico

https://emssolutionsint.blogspot.com/2023/01/paciente-masculino-sobrevive-tras-ser.html

2. Empalamiento 🗡 Lesión by @nirhusmd

https://emssolutionsint.blogspot.com/2023/02/empalamiento-lesion-by-nirhusmd.html

3. ADVERTENCIA IMAGEN GRAFIA: herida penetrante de abdomen por empalamiento por objeto agrícola https://emssolutionsint.blogspot.com/2021/12/advertencia-imagen-grafia-herida.html

 @DrRamonReyesMD #DrRamonReyesMD

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Use of a Rapid Rhino in haemorrhage control for penetrating neck injury presenting in traumatic cardiac arrest

posted by Dr. Ramon Reyes, MD ∞🧩

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C-TECC Meeting. Tuesday, December 5 in Fort Worth, Texas. USA

 

Save-the-Date: December 2023 C-TECC Meeting

Mark your calendars for the December 2023 C-TECC Meeting, which is scheduled to be held on Tuesday, December 5 in Fort Worth, Texas. More information is forthcoming. We are also collecting discussion topics and speaker suggestions for the December Meeting. If you have any ideas to submit, please click here.