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Lesson

Trauma Triage & Destination

10 min Trauma Skip to quiz

Objective: Use ACS-style field triage so the injury matches the right trauma center. Check mental status and vital signs, then anatomy, then mechanism. The closest hospital is not always the right hospital.

Why this matters

The closest hospital is not always the right hospital. Undertriage sends a badly injured patient to a hospital that cannot operate. That delay slows hemorrhage control and neurosurgery. Overtriage fills trauma centers with patients who did not need them.

First, check mental status and vital signs. Then check anatomy, then mechanism, then special considerations. ACS 2021 field triage, and your state version of it, uses that order. Do not choose the hospital by habit.

Key points
  • A gunshot wound to the torso that looks stable still belongs at a trauma center, not the closest clinic.
  • In adults 65 and older, a systolic pressure under 110 mm Hg may already mean shock.
  • If the patient gets worse during transport, triage again and upgrade the destination or the activation per protocol.
Verbalize
  • The closest hospital is not always the right hospital.
  • I will check vital signs and mental status first, then anatomy, then mechanism.
  • For an adult 65 or older, a systolic pressure under 110 may already be shock.
  • If the patient gets worse during transport, we will triage again.

Clinical sequence

  1. Do not assume the closest hospital is the right hospital.
  2. Sort high-risk vital signs and mental status first, then anatomy, then mechanism, then special considerations.
  3. In adults 65 and older, treat a systolic pressure under 110 mm Hg as possible shock.
  4. If the patient gets worse during transport, triage again and upgrade the activation per protocol.

Step Themes

  1. High-risk physiology: the patient cannot follow commands, which ACS 2021 teaching ties to a motor Glasgow Coma Scale score under 6. The patient is in respiratory distress, has an extreme respiratory rate, has low oxygen, or has low blood pressure. These patients go to the highest-level trauma center. In adults 65 and older, a systolic pressure under 110 mm Hg may already mean shock.
  2. High-risk anatomy: penetrating injury to the head, neck, torso, or a limb close to the trunk; chest-wall instability; a suspected pelvic fracture; paralysis; a crushed, mangled, or pulseless extremity; an amputation; bleeding that needs a tourniquet or wound packing; a skull deformity; or two long-bone fractures close to the trunk.
  3. Mechanism is moderate risk. A significant fall, ejection, death of another person in the same compartment, or a high-risk crash raises concern even if the patient looks stable now. Consider a trauma center per your plan.
  4. Special considerations: age 65 and older, a medicine that slows clotting, pregnancy, burns, and your judgment can still change the destination.

EMS Behaviors That Matter

  • Limit scene time for critical trauma. Do the lifesaving care, then continue care during transport.
  • Notify early, using the trauma-activation language your system uses.
  • Use air medical transport when it truly saves time to definitive care, and when it is available and safe.
  • Do not drive past a needed trauma center for convenience if the patient meets criteria.

Key points

  • Triage tools support judgment. An obviously critical patient does not need a long delay while you work through a flowchart.
  • Triage again if the patient gets worse during transport.
  • Document the criteria you used to choose the destination.

Common errors

  • Splinting every minor injury for a long time while the patient is deteriorating.
  • Missing a history of a medicine that slows clotting.
  • Choosing the destination by habit instead of by criteria.

Practice

One-minute check

Say your top physiologic danger criteria from memory. Then give a short radio report for a hypotensive gunshot wound to the torso. Name the destination, and say why. You can polish a fictional report in Narrative Coach.

Related: Massive hemorrhage, Shock.

Sources & Further Study

Named guidelines for further study. They are not clinical orders and do not replace your protocol or medical direction.

Education only. Apply learning within your protocols and medical direction. This is not clinical care guidance.

Check Your Understanding

Questions drawn only from this lesson. After you check, the key is highlighted. Education practice — not a certification exam.

1. Penetrating torso injury, stable now, Level I is 12 minutes farther than the closest ED. ACS-style field triage helps you:
2. Adult trauma patient cannot follow commands and is hypotensive. High-risk physiologic criteria generally include:
3. Critical external hemorrhage controlled; patient still pale. Scene-time theme is:
4. En route to a lower-level facility the patient crashes. You should:
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