Guidelines and procedures of triage in the prehospital setting as stated in BLS 2007, v. 2.0 and Field Trauma Triage and Air Ambulance Utilization Standards Training Bulletin, (2014, issue 113, v. 1.0). Applies to all paramedics in Ontario.

1. FIELD TRAUMA
TRIAGE (FTT)
Guidelines and procedures for Ontario Paramedics
By Michael Wulff

2. FTT – WHAT IS IT?
• A way to assess patients to determine whether to transport
patient(s) to the closest Lead Trauma Hospital (LTH)
• Is used by all paramedics in Ontario

3. FTT – WHAT IS IT?
• Was initially part of the Air Ambulance
Utilization Standards (AAUS) from the
BLS (2007, v 2.0)
• In 2014 was updated and made into its
own standard, separate from AAUS (will
be included in the new BLS, whenever
that comes out…)

4. FTT – THE 4 STEPS
• FTT is a four step process - each step has a different type of criteria:
• Step 1) Physiological
• Step 2) Anatomical
• Step 3) Mechanism of Injury
• Step 4) Special Considerations
• The steps are sequential – Start with step 1, if the patient doesn’t fit into that step go to step 2,
Etc.
• Steps 1 & 2 are used to determine the most seriously injured patients
• Steps 3 & 4 are not absolute criteria

5. 4 STEPS – STEP ONE:
PHYSIOLOGICAL
• Patients should be transported directly to an LTH if <30 min
land transport time AND if any of the following criteria have
been met:
• GCS <14 with evidence of trauma or a traumatic mechanism
• SBP <90mmHg
• Respiratory rate <10 OR >30 breaths/min OR need for
ventilatory support (<20bpm for infants <1 year)

6. 4 STEPS – STEP ONE:
PHYSIOLOGICAL
Other info:
• Transport time is from depart scene to arrive at destination.
• 30 minutes is an approximation
• If can’t manage the airway or if the patient is unlikely to
survive transport to the LTH, go to closest ED

7. 4 STEPS – STEP TWO:
ANATOMICAL
• Transport to LTH if <30 min land transport time AND if:
• penetrating injuries to head, neck, torso and extremities proximal to elbow
or knee. (regardless of lack of vital signs)
• Chest wall instability or deformity
• Two or more proximal long-bone fractures
• Crushed, de-gloved, mangled or pulseless extremity
• Amputation proximal to wrist or ankle
• Pelvic fractures
• Open or depressed skull fracture
• Paralysis

8. 4 STEPS – STEP TWO:
ANATOMICAL
• Other:
• These patients should be transported preferentially to a LTH.
• consider using the Trauma TOR when appropriate.

9. 4 STEPS – STEP THREE:
MECHANISM
• 4 types of criteria
• 1) Falls
• 2) High Risk Auto Crash
• 3) Auto vs. pedestrian/bicyclist
• 4) Motorcycle crash >30 km/h
• Remember, Step Three criteria are NOT absolute
• May patch base hospital physician

10. 4 STEPS – STEP THREE:
MECHANISM
• Criteria 1 and 2:
• 1) Falls
• Adults >6 metres (one story is equal to 3 metres)
• Children (age <15) >3 metres or two to three times the height of the child
• 2) High Risk Auto Crash
• Intrusion >0.3 metres occupant site; >0.5 metres any site, including the roof
• Ejection(partial or complete) from automobile
• Death in the same passenger compartment
• Vehicle telemetry data consistent with high risk injury (if available)

11. 4 STEPS – STEP THREE:
MECHANISM
• Criteria 3 and 4:
• 3) Auto vs. pedestrian/bicyclist thrown, run over or with significant impact (>30
km/h)
• 4) Motorcycle crash >30 km/h

12. 4 STEPS – STEP FOUR: SPECIAL
CONSIDERATIONS
• 4 Considerations
• 1) Age
• 2) Anticoagulation and bleeding disorders
• 3) Burns
• 4) Pregnancy
• Remember, Step Four criteria are NOT absolute
• May patch base hospital physician
• If criteria NOT met, transport to closest ED

13. 4 STEPS – STEP FOUR: SPECIAL
CONSIDERATIONS
• 1) Age
• Older adults
• Risk of injury/death increases after age 55
• SBP <110 may represent shock after age 65
• Children
• Should be triaged preferentially to a pediatric-capable trauma
centre
• 2) Anticoagulation and bleeding disorders
• 3) Burns
• With trauma mechanism: triage to LTH
• 4) Pregnancy >20 weeks

14. FTT – FLOWCHART

15. FTT AND AAUS
• Request for air ambulance transport is indicated when at
least one of the Operational Guidelines plus one of the
Clinical Guidelines are met
• Clinical guidelines include
• all the FTT criteria and
• the medical and obstetrical considerations
• (listed in the AAUS)

16. Whew, so much info!
At least you don’t need to worry about
crashing a helicopter…

17. REFERENCES
• Training Bulletin, Field Trauma Triage and Air Ambulance Utilization Standards (June 2014, Issue
113, version 1.0) Emergency Health Services Branch Ministry of Health and Long-Term Care
• Basic Life Support – Patient Care Standards (January 2007, version 2.0) Emergency Health
Services Branch Ministry of Health and Long-Term Care
• http://www.dailypost.co.uk/news/uk-world-news/world-pictures-9-2013-helicopter-3565726