In April 2011, a panel composed of professionals with expertise in acute injury care, including EMS providers and medical directors, state EMS directors, hospital administrators, adult and pediatric emergency medicine physicians, nurses, adult and pediatric trauma surgeons, persons in the automotive industry, public health personnel and representatives of federal agencies met to discuss the articles, recommendations of the working group and the experiential base from states and communities implementing the Guidelines to reaffirm or revise the final version.
Changes include:
Physiologic Criteria
- Change GCS <14 to GCS ?13; and
- Add “or need for ventilatory support” to respiratory criteria.
Anatomic Criteria
- Change “all penetrating injuries to head, neck, torso and extremities proximal to elbow and knee” to “all penetrating injuries to head, neck, torso and extremities proximal to elbow or knee;”
- Change “flail chest” to “chest wall instability or deformity (e.g., flail chest);”
- Change “crushed, degloved, or mangled extremity” to “crushed, degloved, mangled, or pulseless extremity”; and
- Change “amputation proximal to wrist and ankle” to “amputation proximal to wrist or ankle”
Mechanism-of-Injury Criteria
- Add “including roof” to intrusion criterion.
Special Considerations
- Add the following to older adult criteria:
- SBP <110 might represent shock after age 65 years; and
- Low-impact mechanisms (e.g., ground-level falls) might result in severe injury.
- Add “patients with head injury are at high risk for rapid deterioration” to anticoagulation and bleeding disorders criterion; and
- Remove “end-stage renal disease requiring dialysis” and “time-sensitive extremity injury.”
Transition Boxes
- Change layout of the figure; and
- Modify specific language of the transition boxes.
Copies of the 2011 Guidelines are available at www.cdc.gov/fieldtriage.