CDC Publishes 2011 Guidelines for Field Triage

The expert panel added "or need for ventilatory support" to the respiratory rate criteria out of a recognition that adults and children requiring advanced airway interventions are a very high-risk group.

CDC published the 2011 Guidelines for Field Triage of Injured Patients in the Jan. 13, 2012, edition of Morbidity and Mortality Weekly Report. These guidelines replace the 2006 Guidelines that were published in 2009. The agency said the new ones include changes to the decision scheme for EMS providers who care for and transport injured patients.

The 2011 Guidelines have been endorsed by 37 EMS professional and trade organizations and the Federal Interagency Committee on Emergency Medical Services "and have concurrence from the National Highway Traffic Safety Administration," according to CDC.

These new recommendations from the National Expert Panel on Field Triage include modifications to the Glasgow Coma Scale and Respiratory Rate criteria in Step One, when EMS personnel identify critically injured patients by assessing their level of consciousness (Glasgow Coma Scale) and measuring vital signs (systolic blood pressure and respiratory rate). The panel recommended transport to a facility that provides the highest level of care within the defined trauma system if any of these are identified:

  • Glasgow Coma Scale less than or equal to 13
  • Systolic blood pressure of less than 90 mmHg
  • Respiratory rate of less than 10 or more than29 breaths per minute (less than 20 in infants aged less than 1 year) or need for ventilatory support

Because many readers and users of the 2006 Guidelines perceived that the criterion of GCS less than 14 recommended taking patients with a Glasgow Coma Scale (GCS) of less than or equal to 14 to trauma centers, the panel voted unanimously to rewrite the criterion as GCS less than or equal to 13 to clarify this.

The panel added the need for ventilatory support (including bag-mask ventilation and intubation) to the respiratory rate criterion, saying it has been assumed patients requiring ventilatory support would meet the respiratory rate criterion, but "three studies suggest that this is not necessarily the case and demonstrate the importance of considering ventilatory support, in addition to respiratory rate, in identifying seriously injured patients."

The panel considered adding the motor portion of the GCS as an alternative to the GCS total, which includes verbal, eye opening, and motor components, but made no changes.

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