Ala. Admin. Code 420, ch. 420-2-2, app F
The following are criteria for in-hospital medical personnel to enter into the Alabama Trauma System a patient who has been involved in a trauma or burn incident.
Physiological criteria present on arrival or develop during evaluation and observation:
1. A systolic BP < 90 mm/Hg in an adult or child 6 years or older < 80 mm/Hg in a child less than 6 years old.
2. Respiratory distress - rate < 10 or >29 in adults, or <20 or >60 in a newborn
< 20 or > 40 in a child three years or younger
<12 or >29 in a child four years or older.
3. Head trauma with Glasgow Coma Scale score of 13 or less or head trauma with any neurologic changes in a child five or younger. The level of trauma center to which this patient would be transferred would depend on regional secondary triage criteria. Generally only GCS scores of 9 or less are triaged to a Level I Trauma Hospital.
Anatomical Criteria (patient with normal physiologic signs):
1. The patient has a flail chest.
2. The patient has two or more obvious proximal long bone fractures (humerus, femur).
3. The patient has a penetrating injury of the head, neck, torso, or groin, associated with an energy transfer.
4. The patient has in the same body area a combination of trauma and burns (partial and full thickness) of 15% or greater.
5. The patient has an amputation proximal to the wrist or ankle.
6. The patient has one or more limbs which are paralyzed.
7. The patient has a pelvic fracture demonstrated by x-ray or other imaging technique.
8. Significant internal injuries are found during hospital evaluation and the referring hospital does not have the surgical resources to manage them.
Mechanism of Injury Criteria (patient with normal physiologic signs):
This should not be used as criteria for entering a patient into the trauma system except by facilities that lack the resources and/or expertise to properly evaluate a patient for internal injuries. Patients put into the system for this reason could adequately be evaluated by a Level II or Level III trauma hospital.
1. A patient with the same method of restraint and in the same seating area as a dead victim.
2. Ejection of the patient from an enclosed vehicle.
3. Motorcycle/bicycle/ATV crash with the patient being thrown at least ten feet from the motorcycle/bicycle.
4. Auto versus pedestrian with significant impact with the patient thrown, or run over by a vehicle.
5. An unbroken fall of twenty feet or more onto a hard surface. Unbroken fall of 10 feet or 3 times the height of the child onto a hard surface.
Burn Criteria:
Indications for entering the patient into the trauma system and transferring to a burn center include the following:
1. Partial thickness burn of greater than 10% of the total body surface area.
2. Burns that involve the face, hands, feet, genitalia, perineum, or major joints.
3. Third-degree burns in any age group.
4. Electrical burns, including lightning injury.
5. Chemical burns.
6. Inhalation injury.
7. Burn injuries in patients with preexisting medical disorders that could complicate management, prolong recovery, or affect mortality.
8. Any patient with burns and concomitant trauma (such as fractures) in which the burn injury poses the greatest risk of morbidity or mortality. In such cases, if the trauma poses the greater immediate risk, the patient's condition may be stabilized initially in a trauma center before transfer to a burn center.
9. Burned children in hospitals without qualified personnel or equipment for the care of children.
10. Burn injury in patients who will require special social, emotional, or rehabilitative intervention.
NOTES:
1. Patients entered into the system for Physiologic criteria may be transferred by calling the Alabama Trauma Communications Center (ATCC) 1-800-359-0123.
2. Patients entered into the trauma system for Burn criteria may be transferred by calling the ATCC for availability of appropriate bed (floor vs. ICU) at ready burn center. When availability of a bed is confirmed, the ATCC will connect the transferring physician with the receiving surgeon (if immediately available) at the ready burn center to discuss any stabilization that should be done prior to transfer.
3. Facilities wishing to enter a patient into the trauma system for Anatomic or Mechanism of Injury criteria should call the ATCC who can identify the appropriate ready hospital and can facilitate the transferring physician consulting with a receiving physician to discuss the transfer.
Ala. Admin. Code 420, ch. 420-2-2, app F
Author: John Campbell, M.D.
Statutory Authority: Code of Ala. 1975, § 22-11D-1, et. seq., Alabama Legislature, Act 299, Regular Session, 2007.