F Template for In-House Triage for Trauma Centers

Section 515 Section 515.APPENDIX F   Template for In-House Triage for Trauma Centers It is expected that each trauma center will expand upon the minimum triage set based on individual assessments, resources and outcomes.  The criteria are consistent with the Minimum Trauma Field Triage Criteria for transport to a trauma center. a)         Patient Evaluation 1)         Any EMS System transported patients who are classified under Category I in the Minimum Trauma Field Triage Criteria require rapid transport to a trauma center if less than 25 minutes from the trauma center; otherwise, follow Section 515.Appendix C.  Mandatory field notification of a trauma surgeon will occur in cases of: A)        Sustained hypotension (blood pressure less than or equal to 90 Hg systolic for an adult and less than or equal to 80 Hg for a pediatric patient on two consecutive measures five minutes apart); or B)        Cavity penetration of the torso or neck. 2)         Patients who are classified in the field or in any pre-hospital setting shall be evaluated by the ED's attending emergency physician or designee immediately upon arrival.  (Section 515.2060(a)) 3)         Patients who are not classified as trauma prior to arrival shall be evaluated to assess whether they should be classified as a trauma patient within 10 minutes after arrival.  (Section 515.2060(b)) 4)         Within the above 10 minute evaluation period, the patient must be determined to be Category I or Category II.  The response periods for both categories are described below. 5)         Patients may be upgraded at any time during ED treatment.  The surgeon response time requirements begin at the time of upgrade. 6)         Once the patient has been assigned a Category I or II status that patient cannot be downgraded until the patient is evaluated by the trauma surgeon or appropriate subspecialist. b)         Category I The trauma center must activate its trauma team response (which includes a trauma surgeon, resident or other surgical specialty in lieu of the trauma surgeon) for patients who meet these criteria.  Level II trauma centers require a 30-minute response from the time of identification of need.  If a back-up surgeon is used, the 30-minute time for response is based on the trauma patient identification time, not the time of the contact to the back-up surgeon.  Any patient can be made a Category I based on the ED physician's discretion. Any patient meeting the definition of isolated injury requires consultation with the appropriate subspecialist within 60 minutes after trauma patient identification, except for neurosurgery and Level I OB/GYN, pediatric surgery and cardiovascular surgery.  When neurosurgical intervention has been identified, the neurosurgeon must arrive and be available in a fully staffed operating room within 60 minutes after the identification of the need for operative intervention.  In a Level I trauma center, the OB/GYN, pediatric surgery or cardiovascular surgical subspecialist must arrive within 30 minutes after notification of the subspecialist that his or her services are needed at the hospital.  Where specialty services are provided by transfer agreement, a transfer to a specialty center shall commence within 30 minutes after the patient's arrival, and shall be completed within two hours.  An isolated injury refers to transfer of energy to a single anatomic body region with no potential for multisystem involvement. c)         Category II Any other patient who is admitted for traumatic injury requires notification/consultation with the trauma surgeon or subspecialist at the time the decision to admit is made.  The patient will be seen by the trauma surgeon or appropriate surgical subspecialist within 12 hours after emergency department arrival. Any patient meeting the definition for isolated injury requires a telephone consultation with the appropriate subspecialist (within 60 minutes Level II and 30 minutes Level I) of identified need by the emergency department physician.  When the need for neurosurgical intervention has been identified, the neurosurgeon must be available in a fully staffed operating room within 60 minutes after the identification of need for operative intervention.  Where specialty services are provided by transfer agreement, a transfer to a specialty center shall commence within 30 minutes after the patient's arrival, and the transfer shall be completed within two hours.  An isolated injury refers to the transfer of energy to a single anatomic body region with no potential for multisystem involvement. Category I criteria include at minimum but are not limited to items in the Category I box, Minimum Trauma Field Triage Criteria (Section 515.Appendix C). Category II criteria include at minimum but are not limited to items in the Category II box, Minimum Field Triage Criteria (Section 515.Appendix C).