Trauma Triage & Destination

Why This Is Hard

The closest hospital is not always the right hospital. Undertriage delays hemorrhage control and neurosurgery; overtriage floods centers. CDC field triage style decision schemes (and state variants) guide step-wise thinking: vitals → anatomy → mechanism → special considerations.

Step Themes (Education)

1. Physiologic: unstable vitals, AMS, respiratory compromise — high priority for highest appropriate level.
2. Anatomic: penetrating torso, flail chest, mangled extremities, paralysis, pelvic instability themes, burns with trauma, etc.
3. Mechanism: falls, ejection, death in same compartment, high-risk crashes — raises suspicion even if currently “stable.”
4. Special populations: extremes of age, anticoagulation, pregnancy, burns — may change destination.

EMS Behaviors That Matter

• Limit scene time for critical trauma — “load and go” with care en route.
• Early notification / trauma activation language your system uses.
• Air medical when it truly saves time to definitive care and is available/safe.
• Do not pass a needed trauma center for convenience if the patient meets criteria.

Key Points for Paramedics

• Triage tools support judgment; obvious critical patients do not need a long flowchart delay.
• Re-triage if the patient deteriorates en route.
• Document criteria used for destination choice.

Field Pitfalls

• Prolonged splinting of every minor injury on a crashing patient.
• Missing anticoagulation history.
• Choosing destination by habit instead of criteria.

Practice

Review your regional trauma destination plan and quote the top physiologic criteria from memory. Related: Massive hemorrhage, Shock.

Sources & Further Study

• CDC Guidelines for Field Triage of Injured Patients education concepts; your regional trauma plan.