| Level I |
| Trauma Surgeon’s presence required within
15 minutes of patient arrival
|
Airway
- Intubated
- Active assisted ventilation
- Unstable airway (severe facial injuries)
|
Breathing
- Inability to ventilate/oxygenate
- Sustained respiratory rate >30
- Sucking chest wound
- Needle Decompression
|
Circulation
- Sustained heart rate > 130
- SBP:
- Age <10 y/o: SBP < 70mmHg + (2 x age)
- Age 10-65 y/o: SBP < 90 mmHg
- Age >65 y/o: SBP < 100 mmHg
- Traumatic arrest
- Acute uncontrolled hemorrhage of any source
- Transfer patients receiving blood or vasopressors
|
Disability
- GCS < 8 with trauma mechanism
|
Extremity/Environment/Event
- Amputation proximal to wrist or ankle
- Penetrating trauma to head, neck, chest, abdomen, torso, or groin
- Emergency physician’s discretion
- Deterioration of previously stable patient (ED upgrade after arrival)
|
| Level II |
| |
| Breathing
|
Circulation
- Sustained heart rate 110-130
|
Disability
- GCS 9-13 with trauma mechanism
- Open or depressed skull fracture
- Paralysis or other focal neurological deficit
|
Extremity/Environment/Event
- 2 or more proximal long bone fractures
- Any open long bone fracture
- Crushed, degloved, mangled, or pulseless extremity
- Penetrating injury to extremities
- Suspected pelvic fracture
- Burns with mechanism attributed to trauma
- Trauma transfer from outside hospital
|
| |
| Level III |
| |
| Disability
|
Extremity/Environment/Event
- Arrival by helicopter
- May be higher activation level based on clinical report
- Falls > 20 feet for adults
- Falls > 10 feet for children < 10 y/o
- Ground level fall in patients >65 y/o with external signs of head trauma
- Auto vs. pedestrian or bicyclist > 20 mph
- Ejection from automobile
- Separation of rider from motorcycle, personal watercraft or livestock
- Death in same passenger compartment
- Extensive intrusion to vehicle (>18inches)
- MCC, ATV, bicycle crash >25 mph
- High-speed automobile rollover (>55mph)
- Tractor rollover or crash
- Prolonged extrication time (< 20 minutes)
- High energy electrical injury with burns or lightning strike
- EMS calling a “Trauma Alert”
|
| Notes |
| Patients <15 y/o meeting Level I or II Activation Criteria should be triaged to a pediatric trauma center unless trauma arrest or unstable airway. |
Upgrade Trauma Activation Level by one level when a patient also has a co-morbid condition such as:
- cirrhosis,
- end stage renal disease requiring dialysis,
- severe cardiac or respiratory disease,
- history of bleeding disorder or use of anticoagulant or antiplatelet drugs (excluding aspirin) or
- pregnancy reported to be >20 weeks.
|
| Level III criteria applicable if patient presents < 12 hours post-injury. |
*Early Notification: Advising Medical Dispatch of “Possible Trauma Activation” for a call you are responding on.
*Early Activation: Clear, concise, and accurate patient report as soon as possible so a Trauma Team will be awaiting your arrival.
