Alabama Administrative Code › Title 420 - ALABAMA STATE BOARD OF HEALTH › Chapter 420-2-2 - ALABAMA STATEWIDE TRAUMA SYSTEM › Appendix F - Trauma System Patient Entry Criteria For Hospitals

Current through Register Vol. 42, No. 9, June 28, 2024
The following are criteria for in-hospital medical personnel to
				enter into the Alabama Trauma System a patient who has been involved in a
				trauma or burn incident.
Physiological criteria present on arrival or develop
				during evaluation and observation:
1. A systolic BP < 90 mm/Hg in an adult or child 6 years or
				older < 80 mm/Hg in a child less than 6 years old.
2. Respiratory distress - rate < 10 or >29 in adults, or
				<20 or >60 in a newborn
< 20 or > 40 in a child three years or younger
<12 or >29 in a child four years or older.
3. Head trauma with Glasgow Coma Scale score of 13 or less or
				head trauma with any neurologic changes in a child five or younger. The level
				of trauma center to which this patient would be transferred would depend on
				regional secondary triage criteria. Generally only GCS scores of 9 or less are
				triaged to a Level I Trauma Hospital.
Anatomical Criteria (patient with normal physiologic
				signs):
1. The patient has a flail chest.
2. The patient has two or more obvious proximal long bone
				fractures (humerus, femur).
3. The patient has a penetrating injury of the head, neck,
				torso, or groin, associated with an energy transfer.
4. The patient has in the same body area a combination of
				trauma and burns (partial and full thickness) of 15% or greater.
5. The patient has an amputation proximal to the wrist or
				ankle.
6. The patient has one or more limbs which are
				paralyzed.
7. The patient has a pelvic fracture demonstrated by x-ray or
				other imaging technique.
8. Significant internal injuries are found during hospital
				evaluation and the referring hospital does not have the surgical resources to
				manage them.
Mechanism of Injury Criteria (patient with normal
				physiologic signs):
This should not be used as criteria for entering a patient into
				the trauma system except by facilities that lack the resources and/or expertise
				to properly evaluate a patient for internal injuries. Patients put into the
				system for this reason could adequately be evaluated by a Level II or Level III
				trauma hospital.
1. A patient with the same method of restraint and in the same
				seating area as a dead victim.
2. Ejection of the patient from an enclosed vehicle.
3. Motorcycle/bicycle/ATV crash with the patient being thrown
				at least ten feet from the motorcycle/bicycle.
4. Auto versus pedestrian with significant impact with the
				patient thrown, or run over by a vehicle.
5. An unbroken fall of twenty feet or more onto a hard surface.
				Unbroken fall of 10 feet or 3 times the height of the child onto a hard
				surface.
Burn Criteria:
Indications for entering the patient into the trauma system and
				transferring to a burn center include the following:
1. Partial thickness burn of greater than 10% of the total body
				surface area.
2. Burns that involve the face, hands, feet, genitalia,
				perineum, or major joints.
3. Third-degree burns in any age group.
4. Electrical burns, including lightning injury.
5. Chemical burns.
6. Inhalation injury.
7. Burn injuries in patients with preexisting medical disorders
				that could complicate management, prolong recovery, or affect mortality.
8. Any patient with burns and concomitant trauma (such as
				fractures) in which the burn injury poses the greatest risk of morbidity or
				mortality. In such cases, if the trauma poses the greater immediate risk, the
				patient's condition may be stabilized initially in a trauma center before
				transfer to a burn center.
9. Burned children in hospitals without qualified personnel or
				equipment for the care of children.
10. Burn injury in patients who will require special social,
				emotional, or rehabilitative intervention.
NOTES:
1. Patients entered into the system for Physiologic criteria
				may be transferred by calling the Alabama Trauma Communications Center (ATCC)
				1-800-359-0123.
2. Patients entered into the trauma system for Burn criteria
				may be transferred by calling the ATCC for availability of appropriate bed
				(floor vs. ICU) at ready burn center. When availability of a bed is confirmed,
				the ATCC will connect the transferring physician with the receiving surgeon (if
				immediately available) at the ready burn center to discuss any stabilization
				that should be done prior to transfer.
3. Facilities wishing to enter a patient into the trauma system
				for Anatomic or Mechanism of Injury criteria should call the ATCC who can
				identify the appropriate ready hospital and can facilitate the transferring
				physician consulting with a receiving physician to discuss the
				transfer.
Author:
John Campbell, M.D.
Statutory Authority:
Code of Ala. 1975, §
										22-11D-1, et. seq., Alabama
				  Legislature, Act 299, Regular Session, 2007.