TRAUMA SYSTEM PATIENT ENTRY CRITERIA FOR HOSPITALS

The following are criteria for inhospital 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. 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. 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. 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):

4. 1.   The patient has a flail chest.
5. 2.   The patient has two or more obvious proximal long
   bone fractures (humerus, femur).
6. 3.   The patient has a penetrating injury of the head,
   neck, torso, or groin, associated with an energy        transfer.
7. 4.   The patient has in the same body area a
   combination of trauma and burns (partial and full
   thickness) of 15% or greater.
8. 5.   The patient has an amputation proximal to the
   wrist or ankle.
9. 6.   The patient has one or more limbs which are
   paralyzed.
10. 7.   The patient has a pelvic fracture demonstrated by
    xray or other imaging technique.

11. 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.

12. 1.  A patient with the same method of restraint and in
    the same seating area as a dead victim.
13. 2.  Ejection of the patient from an enclosed vehicle.
14. 3.  Motorcycle/bicycle/ATV crash with the patient being
    thrown at least ten feet from the
    motorcycle/bicycle.
15. 4.  Auto versus pedestrian with significant impact with
    the patient thrown, or run over by a vehicle.

16. 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:

17. 1.   Partial thickness burn of greater than 10% of the total body
    surface area.
18. 2.   Burns that involve the face, hands, feet, genitalia,
    perineum, or major joints.
19. 3.   Thirddegree burns in any age group.
20. 4.   Electrical burns, including lightning injury.
21. 5.   Chemical burns.
22. 6.   Inhalation injury.
23. 7.   Burn injuries in patients with preexisting medical
    disorders that could complicate management,
    prolong recovery, or affect mortality.
24. 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.
25. 9.   Burned children in hospitals without qualified
    personnel or equipment for the care of children.

26. 10.  Burn injury in patients who will require special
    social, emotional, or rehabilitative
    intervention.

    NOTES:

27. 1.  Patients entered into the system for Physiologic criteria may
    be transferred by calling the Alabama Trauma Communications
    Center (ATCC) 18003590123.
28. 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.
29. 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.

Author: John Campbell, M.D.

Statutory Authority: Code of Ala. 1975, §22-11D-1, et. seq., Alabama Legislature, Act 299, Regular Session, 2007.

History: New Rule: Filed December 17, 2008; effective January 21, 2009. Amended: Filed September 17, 2009; effective October 22, 2009. Amended: Filed March 20, 2014; effective April 24, 2014.