CHICAGO: In the United States, unintentional injury is a leading cause of death, with injury being the most common reason for calling 9-1-1 to activate emergency medical services (EMS).1, 2 To improve clinical outcomes, a process of field triage is needed to identify seriously injured patients and quickly transport them to the appropriate care facility. The first Field Triage Decision Scheme was developed in 1986 and has been updated periodically over the past three decades. The most recent version, updated in 2021, is published online in the Journal of Trauma and Acute Care Surgery.
An interdisciplinary expert panel led by the American College of Surgeons (ACS) undertook the 2021 revision with support from the National Highway Traffic Safety Administration’ (NHTSA) Office of EMS, the Health Resources and Services Administration’s (HRSA) Maternal and Child Health Bureau, and EMS for Children Program. It was based on a series of scientific literature reviews conducted by Oregon Health and Science University as well as a broad EMS stakeholder feedback tool, which aimed to capture the perspective from EMS clinicians working in the field.
This update is designed to improve the usability, performance, adherence, and application of the guideline. The guideline is based on the most current science and direct feedback from EMS clinicians to improve prehospital care of injured patients across the country. The new guideline will be most effective when fully implemented into trauma systems and adopted by EMS clinicians.
“The Field Triage Guideline for Injured Patients assists EMS clinicians in identifying the patients at greatest risk of severe injury after a traumatic event and directing high-risk patients to the most appropriate trauma center available to care for them. Getting the right patient to the right place at the right time saves lives,” said Eileen M. Bulger, MD, FACS, Medical Director of ACS Trauma Programs.
The importance of a field triage guideline
“Field triage is the process of identifying seriously injured patients in need of care in specialized trauma centers from among the larger number of patients with minor to moderate injuries who can be cared for in lower-level trauma centers or non-trauma hospitals,” authors note in the recently published article.
An effective field triage guideline has a dual purpose: it seeks to eliminate under-triage, when a seriously injured patient is taken to a hospital lacking the resources needed for appropriate care; and it sets forth a manageable level of over-triage, when a patient with minor to moderate injuries is taken to a trauma center unnecessarily, resulting in overuse of limited resources in the trauma system.
Properly triaging and transporting patients with serious injuries to a trauma center can improve outcomes. Studies show there is 20% lower in-hospital mortality and 25% lower 1-year mortality among patients treated at a Level I trauma center compared with non-trauma hospitals.3
“EMS clinicians play a vital role in our communities as they respond to difficult, life-threatening emergencies. For more than 50 years, the U.S. Department of Transportation and NHTSA have supported EMS systems and first responders in their important mission,” said Steven Cliff, PhD, NHTSA’s Deputy Administrator. “The Field Trauma Triage Guidelines are an important resource for EMS clinicians, helping them save lives and provide critical care for traumatic injuries. We appreciate the American College of Surgeons’ leadership on this essential publication.”
Guideline updates
Among the updates included in the 2021 guideline are substantive changes to its format and structure. Previously, the guideline used a step-wise algorithmic format that was determined to be overly complex for use in the field. The new guideline was redesigned to reflect the flow of information to EMS clinicians and actual use of the guideline in the field.
The restructure consolidates triage criteria into two main categories based on risk of serious injury: high risk criteria (red) and moderate risk criteria (yellow). Each category is accompanied by a recommendation indicating the patient transport destination.
The guideline, resources, and implementation tools can be found at www.facs.org/fieldtriageguidelines.
Citation: National Guideline for the Field Triage of Injured Patients: Recommendations of the National Expert Panel on Field Triage, 2021. Journal of Trauma and Acute Care Surgery. DOI: 10.1097/TA.0000000000003627
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- 10 Leading Causes of Death, United States 2019, Both Sexes, All Ages, All Races. Centers for Disease Control and Prevention; 2021. Available at: https://wisqars-viz.cdc.gov:8006/lcd/home. Accessed March 30, 2022.
- Wang HE, Mann NC, Jacobson KE, Ms MD, Mears G, Smyrski K, et al. National characteristics of emergency medical services responses in the United States. Prehosp Emerg Care. 2013;17(1):8-14.
- MacKenzie EJ, Rivara FP, Jurkovich GJ, Nathens AB, Frey KP, Egleston BL, et al. A national evaluation of the effect of trauma-center care on mortality. N Engl J Med. 2006;354(4):366-78.
