Regional Emergency Medical Advisory Committee of New York City Prehospital Advanced Life Support Protocols Copyright January 1996 (3/96)

Mechanism of Injury

1. All patients who have fallen 2 stories (15 feet) or more.
2. All surviving passengers of fatal or high speed motor vehicle crashes who have complaints of significant injury.
3. All pedestrians who have sustained significant injuries as the result of being struck by a moving vehicle.
   

Physical Findings

1. Glascow Coma Scale score of less than 13.
2. All trauma patients with an Adult Revised Trauma Score of 11 or less, or a Pediatric Trauma Score of 8 or less.
3. All blunt trauma to the head with a history or presence of any of the following:
   • a) loss of consciousness;
   • b) posturing or seizure;
   • c) lateralizing signs;
   • d) open cranial injury;
   • e) paralysis;
   • f) significant symptoms such as, severe headache, vomiting, dizziness, amnesia, or double vision.
4. Patients with blunt trauma to the chest with a history or the presence of any of the following:
   • a) respiratory insufficiency;
   • b) decreased breath sounds
   • c) deviated trachea;
   • d) distended neck veins;
   • e) subcutaneous emphysema;
   • f) signs of multiple rib fractures.
5. Patients with blunt trauma to the abdomen with a history or the presence of any of the following:
   • a) pain;
   • b) tenderness;
   • c) distention;
   • e) discoloration.
6. All blunt trauma of the extremities with accompanying hypotension.
7. All penetrating trauma of head, neck, chest, abdomen, groin or buttocks.
8. All penetrating trauma of the extremities with accompanying hypotension.
9. Trauma to the extremities with vascular compromise.
10. Pelvic fracture, or 2 or more long bone fractures.
11. Pelvic fracture, or 1 long bone fracture associated with head, chest or abdominal injury.
12. Burn patients with associated hemorrhage or significant trauma should be treated as trauma patients.
13. Traumatic amputation (except digits).
    

EXTREMIS CRITERIA

1. Traumatic cardiac arrest.
2. Obstructed or unmanageable airway.

NOTE:	MAJOR TRAUMA PATIENTS SHOULD BE TRANSPORTED TO A TRAUMA CENTER PROVIDED IT IS NOT MORE THAN 20 MINUTES AWAY. (SEE APPENDIX H.)
	MAJOR TRAUMA PATIENTS IN EXTREMIS SHOULD BE TRANSPORTED TO THE NEAREST 911 AMBULANCE DESTINATION EMERGENCY DEPARTMENT. (SEE APPENDIX I.)

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