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