At times, there is so much damage and destruction to a vehicle or at the scene of the accident that you can’t help but think the patient has to be severely injured and in need of a trauma center. From my perspective, I think it can be difficult to properly triage patients when you’re looking at the scene of an accident. Medic Marshall: The Doc hit this one on the head. Otherwise, you can probably feel comfortable taking the rest of your trauma patients to the nearest appropriate facility and not over burden the Level One Center with patients who don’t need that level of care. If these criteria are absent, however, then perhaps you should consider transporting the patients with the three highest risk MOIs to a Level One Center.
Three of these MOI consistently identified those patients who might benefit from being transported directly to a Level One Trauma center.ĭespite all of this data, it’s vital to remember that this study applies only to patients without anatomic or physiologic criteria consistent with a major traumatic injury. pedestrian/bicyclist thrown, run over, or with significant (> 20 miles per hour) impact “¢ Vehicle telemetry data consistent with high risk of injury “¢Ğjection (partial or complete) from automobile “¢Ĝhildren: >10 ft., or 2-3 times the height of the child The mechanisms that the CDC recommends should go to the closest facility include the following: What this means is that these three Level One Trauma centers appear to be used exclusively for all trauma patients and may not be using Level Two or Three centers to receive patients with MOI criteria alone.ĭespite this limitation, the authors provide some clarity as to the value of each of the CDC mechanisms they list.
Patients who meet the MOI criteria should be taken to the closest appropriate hospital, which does not necessarily mean the highest level of care. The Centers for Disease Control & Prevention (CDC) criteria states that only those meeting anatomic and/or physiologic criteria should be transported to the highest level trauma center in the system. Why were these patients not transported to other hospitals? First, all the patients studied were taken to a Level One Center, and the authors determined that 91% of the patients transported solely based on MOI didn’t need Level One Center resources. To appreciate this study, it’s important to recognize some of its limitations. Wesley: This study provides us with insight into the value or lack thereof to using Mechanism of Injury (MOI) as the sole determinant for deciding to transport a trauma patient to a Level One trauma center. They included 1) Death of an occupant in the vehicle 2) Fall greater than 20 feet and 3) Extrication time > 20 minutesĭr. They determined that of all of the MOIs listed in the CDC triage criteria only three reliably predicted the need for a Level One Trauma center. They defined trauma center need as 1) Died, 2) ICU admission, and/or 3) Non-orthopedic surgery within 24 hours of admission.
They then examined the Mechanism of Injury (MOI) that was associated with the admission and determined whether or not the patient needed the resources of the Level One Trauma center.