Universal Medical Rescue Protocol Changed: “High Speed Auto Crash” Changed to “High Risk Auto Crash” in the Field Triage Decision Scheme

At a crash scene, EMS providers must not only determine the severity of injury and initiate medical management, but also identify the most appropriate transport destination facility through a process called “field triage.” Proper decision making has a very significant impact on the outcome of injured subjects. Step III of the Field Triage Decision Scheme addresses mechanisms of injury and previously included “High Speed Auto Crash” as supported by initial estimated speed >40 MPH, major auto deformity >20 inches and intrusion into passenger compartment > 12 inches. To take into account recent changes in trauma systems development and vehicle safety engineering and telemetry capabilities, the universally used Field Triage Decision Scheme was revised by a National Expert Panel organized by the Centers for Disease Control and Prevention. An extensive review of published evidence as well as analysis of crash injury databases was performed. New criteria targeted a 20% positive predictive value for Injury Severity Score greater than 15 (ISS>15) since more severely injured patients benefit most from transport to the highest level of trauma care. “High Speed Auto Crash” was revised to “High Risk Auto Crash” as supported by intrusion >12 inches at the occupant site or >18 inches anywhere in the vehicle as well as field telemetry consistent with high risk of injury. Rollover events and prolonged extrication were removed as criteria while death in the same occupant compartment was retained. The occupant ejection criterion was changed to specify both partial and complete ejection. The recent revision of the universally used Field Triage Decision Scheme has potential to greatly improve rescue and treatment of crash injury victims. The addition of “vehicle telemetry consistent with high risk of injury” provides a tremendous opportunity for the automotive and medical communities to work co-operatively to improve crash safety.