Field Triage for On-scene Helicopter Transport

Abstract

This prospective study evaluated the use of basic vital signs, two mechanisms of injury, and time-distance factors as field triage criteria for onscene helicopter transport of 130 patients to a trauma center serving a rural area. The vital signs criteria included any one or more of the following: a) level of consciousness (LOC) ≤ unresponsive to verbal stimulation; b) respiration rate (RR) ≤ 10 or ≤ 30; c) systolic blood pressure (BP) ≤ 90; d) pulse (P) ≤ 60 or ≤ 120. The flight crew recorded vital signs taken by the first responder capable of basic assessment. Entrapment and associated fatalities in motor vehicular accidents were recorded and flight logistics were examined. The presence of one or more abnormal signs identified a group of seriously injured trauma patients (mean Injury Severity Score = 29.1) with 24% mortality compared to a predicted mortality of 32% (p < 0.02). Unresponsiveness to verbal stimulation in the field was the single most predictive criterion, yielding sensitivity of 93% and specificity of 85%. Time-distance criteria were helpful to determine helicopter use.