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FIELD TRAUMA TRIAGE (FTT)Guidelines and procedures for Ontario ParamedicsBy Michael Wulff
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
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…)
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
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)
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
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
4 STEPS – STEP TWO: ANATOMICAL
• Other:
• These patients should be transported preferentially to a LTH.
• consider using the Trauma TOR when appropriate.
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
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)
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
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
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
FTT – FLOWCHART
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)
Whew, so much info!At least you don’t need to worry aboutcrashing a helicopter…
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