GCS score <13 | Ejection from/off a vehicle | EMS provider judgment |
SBP <90 | Vehicle roll-over with unrestrained patient | Age <5 or >55 years |
Respiratory rate <10 or >29 | Death in the same passenger compartment | Pregnancy >20 weeks |
Respiratory compromising or in need of emergent airway | Auto vs. bicyclist/pedestrian thrown, run over, or with significant >20 mph impact | Bleeding disorders |
Respiratory compromising or in need of emergent airway | Fall >3 times the patient’s height or >15 feet | Anticoagulant or antiplatelet agent use (exception: aspirin) |
Intubated patients transferred from the scene | Exposure to blast or explosion | Severe cardiac and/or respiratory disease |
Possible airway compromise | Motorcycle crash >20 mph: ED physician or MICN judgment | Loss of consciousness |
All penetrating injuries to the head, neck, torso or extremities proximal to the elbow/knee | Amputations proximal to wrist/ankle | End-stage renal disease requiring dialysis |
Two or more proximal long bone fractures | Suspected pelvic fractures | Extrication time >20 min |
Combative | Limb paralysis | Intrusion into occupied passenger space >12 inch frontal |
Transfer patients receiving blood to maintain vital signs | Crush injury, degloved or mangled extremity | Intrusion into occupied passenger space >8 inch side |
Flail chest | Neurologic or vascular deficit to extremities | |
| Combination of trauma with burns | |
| Child abuse: known or suspected with significant injury | |