Trauma service criteria

1. Revised: 8/20/2015
Trauma Service Criteria
Level I
*Full Trauma Team Response- Trauma Attending/Fellow (team leader), Trauma Resident/Intern, PED
Attending/Fellow, PED Resident/ Intern, PED RN (3) or PED RN (2) and PED Paramedic (1), PED Care
Partner, PED RT, Social Work, Radiology
Airway/Breathing
 Any intubated patient
 Unstable airway: artificial airway, being bagged
 Airway obstruction
 Significant facial or neck injury causing airway compromise
Breathing
 Respiratory distress/ compromise: increased work of breathing
Circulatory
 Any episode of sustained tachycardia OR hypotension SBP <70 + (2x age in years)
 Cardiac arrest/CPR (in field or en route)
 Blood transfusion en route
 Significant blood loss or hemorrhage
 Penetrating injury (head, neck, torso or proximal extremity)
 Excludes any penetrating injury isolated to the eye
 Limb threatening injuries:
 Amputation, near-amputation, de-gloving, crush injury proximal to wrist/ ankle
 Extremity with no pulse, duskiness, cyanosis, or paralysis
Disability
 GCS ≤ 8 or “P” or “U”
 Worsening neurological exam: decline in GCS by ≥2, decline in AVPU by letter
 Paralysis, motor weakness, decreased sensation, or signs of spinal cord injury
 To include but not limited to the following symptoms: flaccidity, a-reflexia, decreased
strength, numbness/tingling, unexplained hypotension
Other
 Burns
 2nd and/or 3rd degree thermal burns ≥30% TBSA and/or chemical or electrical burns
 ED physician discretion

2. Revised: 8/20/2015
Level II
*Partial Trauma Team Response: Trauma Resident/ Trauma NP/ Trauma PA, PED Attending/Fellow (team
leader), PED Resident/ Intern, PED RN (2) or PED RN (1) and PED Paramedic (1), PED Care Partner,
PED RT, Social Work*
Airway
 Suspected smoke inhalation injury
 Sub-Q emphysema of chest and above
Breathing
 Suspected/confirmed pulmonary contusions/ rib fractures or pneumo/hemothorax
 Suspected chest trauma with NRB necessary to maintain saturations >93%
Circulatory
 Controlled arterial bleeding, stable VS
 Two or more proximal long bone fractures
 Femur fracture with significant mechanism
 Pelvic fractures
 Amputation (near/complete), crush injury, or degloving distal to wrist/ankle to exclude digits
 Penetrating injury to distal extremities excluding digits
Disability
 GCS 9-13 or “V” (combative, disoriented, confused)
 Open or depressed skull fracture
 Confirmed but “stable” epidural/subdural/subarachnoid bleed
 Closed head injury with seizure activity or loss of consciousness
 Suspected/confirmed cervical spine or spinal cord injury without or resolved motor/sensory
deficit
Other:
 Suspected intra-abdominal injury
 Abdominal wall bruising: seat belt sign or handlebar bruise
 Abdominal pain/ tenderness
 Confirmed intra-abdominal organ injury diagnosed prior to transfer
 MVC with: rollover, ejection, death of passenger, significant damage/intrusion, or spider
windshield
 MCC, ATV with rollover, ejection
 Fall >20 feet (2nd
story)
 Struck, dragged, or run over by vehicle
 Penetrating injury isolated to the eye
 2nd and/or 3rd degree thermal burns 29-15% TBSA
 ED physician discretion
Level III
*Partial Trauma Team Response: PED Attending/Fellow, PED Resident/ Intern, PED RN, PED Care
Partner*
Miscellaneous
 Trauma patients not meeting above criteria including patients immobilized with no
significant injury
 2nd
and/or 3rd
degree thermal burns <15% TBSA
 All 1st
degree burns
 Amputation (near/complete), crush injury, or degloving of digits

3. Revised: 8/20/2015
 Penetrating injury to digits
*Any patient can be upgraded to a higher level at the discretion of the attending MD (ED or
Trauma). *
**Patients can ONLY be downgraded if they do not meet level I criteria upon arrival (i.e. EMS
reporting/assessment error. **
Normal Ranges for Pediatric Vital Signs
AGE
(KG)
HR
min – max
SBP min
70+(age in years x 2)
Premie
(1-2)
90-180 70
Newborn
(3.5)
90-180 70
6 month
(7)
85-180 70
1 year
(10)
80-160 72
3 year
(15)
80-160 76
6 year
(20)
70-140 82
8 year
(25)
70-140 86
10 year
(30)
65-140 90
12 year
(40)
60-130 90
15 year
(50)
55-130 90
18 year
(65)
50-130 90