Trauma Scoring
Emergency Medical Technician Basic
EMS Professions
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Trauma Score Uses
 Triage
– Level I Trauma Center?
– Air Transport?
 Assessment
– Tracking condition changes
EMS Professions
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Trauma Score Uses
 Severity
reporting to on-line medical
control, receiving facility
 Research
Outcomes
 Quality
assessment
assurance
EMS Professions
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Scoring Factors

Physiological Status
– Airway
– Breathing
 Presence
 Adequacy
– Circulation/Perfusion
 Presence
 Adequacy
– Disability
EMS Professions
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Scoring Factors
 Mechanism
of Injury
– Kinematics
– Type, direction, amount of force
EMS Professions
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Scoring Factors
 Anatomical
Site of Injury
– Not accurate by self for pre-hospital use
 Visible
soft tissue/ orthopedic injury may
distract from head, chest, abdominal trauma
 Penetrating trauma depth/direction deceiving
 Blunt trauma assessment difficult, especially
abdomen
EMS Professions
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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
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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
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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
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Scoring Factors
 Kinematics--Motor
Vehicle Collisions
– Rollover
– Ejection from vehicle
– Death/Serious injury of same car occupant
EMS Professions
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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
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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
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Revised Trauma Score
Commonly Used Prehospital
Trauma Score
EMS Professions
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Revised Trauma Score
 RTS
component scores based on:
– Glasgow scale
– Respiratory rate
– Systolic BP
 Add
component scores to determine RTS
EMS Professions
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Glasgow Coma Scale
 Motor
Response
– 1 = No response
– 2 = Abnormal extension
– 3 = Abnormal flexion
– 4 = Withdrawal
– 5 = Localizes pain
– 6 = Follows instructions
EMS Professions
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Glasgow Coma Scale
 Verbal
Response
– 1 = No response
– 2 = Incomprehensible sounds
– 3 = Inappropriate words
– 4 = Confused, disoriented
– 5 = Oriented
EMS Professions
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Glasgow Coma Scale
 Eye
Response
– 1 = No response
– 2 = To pain
– 3 = To verbal command
– 4 = Spontaneous
EMS Professions
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Glasgow Coma Scale
Motor + Verbal + Eye = Glasgow Score
What is lowest possible GCS Score?
EMS Professions
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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
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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
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Revised Trauma Score
Systolic
BP
–0 = 0
– 1 = 1 to 49
– 2 = 50 to 75
– 3 = 76 to 89
– 4 = >89
EMS Professions
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Revised Trauma Score
GCS score + Respiratory score + Systolic BP score =
Revised Trauma Score
EMS Professions
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