Trauma Triage: An Introduction

By Leonard J. Weireter, MD (July/Aug, 2001 Response Newsletter)

A region wide disaster drill with seventy-five severely injured moulage patients, and your job is triage officer. The rules are pretty easy, really: START triage, color-coding and move patients to the appropriate treatment area. On a scene, with fifteen injuries, patients from a school bus crash. Maybe no triage tags, but the same rules apply. On the interstate with a single victim. Do the same rules apply? What if it's two or three victims? Who goes where? Who decides?

Triage is the task of sorting by pre-designed criteria in order to provide the best patient care utilizing available resources. While easy to envision for a large number of patients that would easily overload any single institution, the same concept is applicable to lesser number of patients provided they meet the specified injury severity criteria.

Virginia has had an organized statewide trauma system and trauma center designation program since the late 1970's and early 1980's. The state legislature tasked the Joint Commission on Health Care to study the condition of injury care in the Commonwealth in 1995 as a response to a growing sentiment that the trauma system was not being utilized in an equitable manner across the state.

The Joint Commission's report concluded that while there has been a state trauma system and a trauma center designation system in place for many years, there has not been uniform transport or transfer criteria in force anywhere. Citizens of the Commonwealth needed to have access to the highest quality trauma care independent of where they were at the time of injury. The Commissioner of Health was instructed to convene a task force to develop statewide triage criteria for the pre-hospital and inter-hospital transport of injured patients.

After nine months of meeting and negotiation under the chairmanship of Carol Gilbert MD, Trauma Director at Carilion Roanoke Memorial Hospital, a triage plan was developed. The task force, representing all the constituents of the health care team in Virginia, worked from several guiding principles. First, a statewide triage plan needed to be inclusive so as to serve all the injured patients in Virginia. Second, it had to be responsive to regional variability in geography and capability. Third, it needed to be linked to the current trauma center designation program, and finally, there needed to be a method to assess the quality of the performance of the system in delivering such care.

The EMS regions were then instructed to take the state triage criteria and develop a plan for their specific region, since they were in the best position to assess the regional capabilities. A quality assessment program was also required.

TEMS developed a regional trauma triage plan that was approved by the Department of Health in January 2000 (Appendix I of the Regional Medical Protocols). The Tidewater region already had a well-developed, experienced system that functions well. The state triage criteria subsequently were not a major change in operations for most of TEMS.

In the past year TEMS has established a Quality Improvement Committee for the trauma system. This committee, with broad representation from the region, will oversee the performance of the system. They are currently developing the methodology to accomplish this task.

In coming issues look for specific education regarding the trauma triage criteria in TEMS and how to access the Quality Improvement system with your concerns.