Protocol: Critical Trauma Transport

Original Effective Date: 03/29/2003
Situations may arise where transporting patients directly to a Level I or II trauma center is necessary. This may increase overall time to physician evaluation, but should decrease time to definitive care, which should result in improvement of patient outcome.

Definitions:

Level I: Any injury that if not treated within one hour may result in loss of life, limb or permanent disability shall be classified as a Level I Trauma.

Examples for Level I:

GCS<14
Systolic bp <90 associated with suspected hemorrhage causing trauma.
Respiratory Rate <10
Penetrating injury to head, neck, or torso.
Flail chest.
Burns associated with trauma.
2 or more proximal long bone fractures.
Vascular compromise associated with fracture.

These are just a few examples and criteria. It is impossible to list all possibilities of Level I Trauma.

Level II: Any injury that if not treated within eight hours may result in loss of life, limb or permanent disability shall be classified as a Level II Trauma.

Examples for Level II:

Obvious fracture of single long bone with good peripheral pulses.
Fractures of 2 or more long bones distal to knee/elbos with good peripheral pulses.
2nd or 3rd degree burns less than 10% BSA not to hands, feet, or genitalia.
Laceration of minor to moderate severity.

These are just a few examples of Level II trauma. It is impossible to list all possibilities of Level II trauma.

Level III: An injury that if left untreated will not cause a loss of life, limb, or permanent disability.

Examples for Level III:

Isolated injuries not meeting guidelines for Level I or II.
Multiple abrasions and bruising.
Simple Lacerations.

Actions required:

Level I Trauma: The EMT on scene shall imediately request air transport to a Level I Trauma Center for a patient that it would take greater than one hour to transport to Gila Regional Medical Center by Ground. This time shall also include extrication time. The EMT on scene shall then contact On-line Medical Control with patient report and transport status.

Level II Trauma: The EMT on scene shall as soon as possible consult with On-line Medical Control, regarding patient condition and consider imediate transport to Level I Trauma Center, If ground transport time is greater than one hour. If ordered to transport directly to Level I Trauma Center appropriate air transport resources shall then be contacted.

Note: Several other factors may effect decisions to utilize a scene response of air transport and then on to Level I Trauma Centers.

  1. Availability of rapid response of Air Transport.
  2. Inclement weather from aircraft initial location to scene and between scene and Level I Trauma Center.
  3. Excessive numbers of patients exceeding aircraft availability.
  4. Other unforeseeable reasons for delay in air transport arrival at Landing Zones.

Level III Trauma: Level III trauma patients shall generally be transported by ground.