Trauma Scoring
Emergency Medical Technician Basic
EMS Professions
1
Trauma Score Uses
Triage
– Level I Trauma Center? – Air Transport?
Assessment
– Tracking condition changes
EMS Professions
2
Trauma Score Uses
reporting to on-line medical control, receiving facility Research
Outcomes
Quality Severity
assessment
assurance
EMS Professions
3
Scoring Factors
Physiological
Status
– Circulation/Perfusion Presence Adequacy – Disability
– Airway – Breathing Presence Adequacy
EMS Professions
4
Scoring Factors
Mechanism
of Injury
– Kinematics – Type, direction, amount of force
EMS Professions
5
Scoring Factors
Anatomical
Visible
Site of Injury
– Not accurate by self for pre-hospital use
soft tissue/ orthopedic injury may distract from head, chest, abdominal trauma Penetrating trauma depth/direction deceiving Blunt trauma assessment difficult, especially abdomen
EMS Professions
6
Scoring Factors
Anatomical
Site of Injury
– Penetrating trauma Chest, abdomen, head, neck, groin – > 2 long bone fractures – Burns >15% BSA, face, airway – Flail chest – Scalping injury – Paralysis – Amputation proximal to wrist/ankle
EMS Professions
7
Scoring Factors
Co-morbid
Factors
– Burns associated with other major trauma – Age < 5 or > 55 – Known cardiac, respiratory disease – Prolonged extrication/transport time
EMS Professions
8
Scoring Factors
Logistics
– Extrication >20 minutes – Inaccessible scene – Long transport time
EMS Professions
9
Scoring Factors
Kinematics--Motor
Vehicle Collisions
– Speed >20 MPH – Rearward displacement of front axle – Deformity of auto >20 inches – Passenger compartment intrusion >15 inches - patient side >20 inches - opposite side
EMS Professions
10
Scoring Factors
Kinematics--Motor
Vehicle Collisions
– Rollover – Ejection from vehicle – Death/Serious injury of same car occupant
EMS Professions
11
Scoring Factors
Kinematics--Pedestrian
vs Vehicle
– Struck at >20 mph – Thrown > 15 feet – Child < 12 years old
Kinematics--Falls
– >15 feet or >3x victim’s height
EMS Professions
12
Scoring Factors
If
any of scoring factors present:
– Patient will require Level I or II Trauma Center – If transport time >20 minutes consider calling helicopter
EMS Professions
13
Revised Trauma Score
Commonly Used Prehospital Trauma Score
EMS Professions
14
Revised Trauma Score
RTS
component scores based on:
– Glasgow scale – Respiratory rate – Systolic BP
Add
component scores to determine RTS
EMS Professions
15
Glasgow Coma Scale
Motor
Response
– 1 = No response – 2 = Abnormal extension – 3 = Abnormal flexion – 4 = Withdrawal – 5 = Localizes pain – 6 = Follows instructions
EMS Professions
16
Glasgow Coma Scale
Verbal
Response
– 1 = No response – 2 = Incomprehensible sounds – 3 = Inappropriate words – 4 = Confused, disoriented – 5 = Oriented
EMS Professions
17
Glasgow Coma Scale
Eye
Response
– 1 = No response – 2 = To pain – 3 = To verbal command – 4 = Spontaneous
EMS Professions
18
Glasgow Coma Scale
Motor + Verbal + Eye = Glasgow Score
What is lowest possible GCS Score?
EMS Professions
19
Revised Trauma Score
Glasgow
Coma Scale
– 0 = 1 - 3 GCS – 1 = 4 - 5 GCS – 2 = 6 - 8 GCS – 3 = 9 - 12 GCS – 4 = 13 - 15 GCS
EMS Professions
20
Revised Trauma Score
Respiratory
Rate
–0 = 0 Respirations – 1 = 1 to 5 Respirations – 2 = 6 to 9 Respirations –3 = >29 Respirations – 4 =10 to 29 Respirations
EMS Professions
21
Revised Trauma Score
Systolic
BP
–0 = 0 – 1 = 1 to 49 – 2 = 50 to 75 – 3 = 76 to 89 – 4 = >89
EMS Professions
22
Revised Trauma Score
GCS score + Respiratory score + Systolic BP score = Revised Trauma Score
EMS Professions
23