Section 325.138. Criteria for transfer protocols; criteria.

Designated trauma centers shall use all of the following  criteria for trauma patient transfer protocols:

(1)   Central nervous system:

(a)   ) Depressed skull fracture.

(b)   Penetrating injury /open fracture, with or without cerebrospinal  fluid leak.

(c)   GCS <14 or deterioration.

(d)  Spinal cord injury or cerebral vascular injury.

(2)   Chest:

(a)   ) Major chest wall injury or pulmonary contusion.

(b)   Wide mediastinum or other signs suggesting great vessel injury.

(c)   ) Cardiac injury.

(d)  Patients who may require prolonged ventilation.

(e)   Flail chest/multiple rib fractures.

(3)   Pelvis/Abdomen:

(a)   Unstable pelvic ring disruption.

(b)   Pelvic fracture with shock or other evidences of continuing hemorrhage.

(c)   Open pelvic injury.

(d)  Intra-abdominal visceral injury.

(e)   ) Acetabular injury.

(4)   Major Extremity Injuries:

(a)  Fracture/dislocation with loss of distal pulses. (b)Open long-bone fractures.

(c)   Extremity ischemia.

(d)  Compartment syndrome.

(5)   Multiple-system injury:

(a)   ) Head injury combined with face, chest, abdominal, or pelvic injury.

(b)   Burns with any combination of multi-system, injury including inhalation injury.

(c)   ) Multiple long-bone fractures.

(d)  Injury to more than two body regions.

(6)   Comorbid Factors:

(a)  ) Age >55 years.

(b)   Children <5 years.

(c)   ) Cardiac or respiratory disease.

(d)  Insulin-dependent diabetes.

(e)   ) Morbid obesity.

(f)  ) Pregnancy.

(g)   Immunosuppression.

(h)  Liver or renal insufficiency. (7)Secondary deterioration (late sequelae):

(a)  ) Prolonged mechanical ventilation >48 hours.

(b)   Sepsis.

(c)   Single or multiple organ system failure (deterioration in central nervous, cardiac, pulmonary, hepatic, renal, or coagulation systems).

(d)  Major tissue necrosis /soft tissue injury.

History: 2007 AACS.