CDC Revises Field Triage Guidelines

Guidelines published in Thursday's MMWR Reports and Recommendations are aimed at ensuring trauma patients with more severe injuries are taken to trauma centers designed to handle such injuries. The recommendations are designed to standardize decision-making at the injury scene and offer guidance on new technologies such as vehicle crash notification systems, which alert emergency services that a crash has occurred and automatically summon assistance.

Developed by CDC and key experts in trauma care to provide broader access of the information for emergency care services, the report provides the rationale and development process for the revised 2006 Field Triage Decision Scheme: the National Trauma Triage Protocol for emergency medical service (EMS) providers. The goal is to guide the nation’s 800,000 EMS providers in making crucial field triage transport decisions. Previous CDC-funded research has shown that decisions made at the scene of the injury are vital. The risk of death of a severely injured person is 25 percent lower if the patient receives care at a Level 1 trauma center, which has additional resources specifically designed for care of severe trauma.

"Quality and timely care at an injury scene by EMS providers are integral to determining the severity of injury, initiating medical management, and identifying the most appropriate facility to which the patient should be transported," said Richard C. Hunt, M.D., director of CDC's Division of Injury Response, National Center for Injury Prevention and Control and an author of the report. "The Decision Scheme provides a safety net that the public won’t see. But we know it can help improve the chances of survival for severely injured patients."

Other key revisions include recommendations for the right place and right time to best use crucial emergency care resources, and vehicle crash damage criteria that can help determine which patients may require care at a trauma center.

The Decision Scheme was developed in collaboration with the American College of Surgeons-Committee on Trauma with support from the National Highway Traffic Safety Administration (NHTSA). It was reviewed by the 36-member National Expert Panel on Field Triage, which included representatives from EMS, emergency medicine, trauma surgery, the automotive industry, public health, and several federal agencies. The revised guidelines are in line with the 2006 Institute of Medicine report on the state of emergency care. The report envisioned a highly coordinated emergency services system that assures that each patient receives the most appropriate care, at the optimal location, with the minimum delay.

With additional funding from NHTSA, CDC is developing a companion educational initiative for local EMS medical directors, state EMS directors, public health officials, and EMS providers. Educational materials will be tailored to meet the needs of their communities and include: a user’s guide, poster and pocket card of the Decision Scheme, a slide presentation for use in trainings, and the MMWR article that includes continuing education opportunities.

Information and free downloads are available from CDC at www.cdc.gov/FieldTriage. For a complete copy of the MMWR report, visit www.cdc.gov/mmwr.

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