Mass casualties (1):

1. Vorgabe: maximal 2 Minuten/stehendem Patienten bzw. 3 Minuten/liegendem Patienten.
2. Patient kann gehen? Wenn nein -> siehe Punkt 3. Wenn ja -> Betreuung ausserhalb der Gefahrenzone in der Sammelstelle für Leicht- und Unverletzte.
   
3. Patient schreit? Wenn nein -> siehe Punkt 4. Wenn ja -> kann warten.
4. Patient atmet? Wenn nein -> siehe Punkt 5. Wenn ja:
• Atemfrequenz: >= 1 Jahr: <10 oder >29/Minute, oder <1 Jahr: <20 oder >29/Minute. Wenn ja, überprüfe Puls. Wenn nein -> NOTFALL!
• Herzfrequenz: <120 Schläge/Minute. Wenn ja -> überprüfe Pulsqualität. Wenn nein -> NOTFALL!
• Pulsqualität: gut tastbar. Wenn ja -> kann warten. Wenn nein -> NOTFALL!
  
5. Atemweg freilegen. Patient atmet? Wenn nein -> STOP! Wenn ja, siehe Punkt 4.
6. Patient blutet -> Blutstillung erfolgreich? Wenn ja -> kann warten. Wenn nein -> NOTFALL!
   

Field triage decision scheme (1):

• Step 1: measure vital signs and level of consciousness:
• Glasgow coma scale <13
• Systolic blood pressure <90 mmHg
• Respiratory rate:
• <1 year: <20 or >29 breaths/minute
• >=1 year: <10 or >29 breaths/minute
• Need for ventilatory support
• -> These patients should be transported preferentially to the highest level of care within the defined trauma system.
• Step 2: assess anatomy of injury:
• All penetrating injuries to head, neck, torso and extremities proximal to elbow and knee (e.g., flail chest)
• >=2 proximal long-bone fractures
• Crushed, degloved, mangled, or pulseless extremity
• Amputation proximal to wrist or ankle
• Pelvic fractures
• Open or depressed skull fracture
• Paralysis
• -> These patients would be transported preferentially to the highest level of care within the trauma system.
  
• Step 3: assess the mechanism of injury and evidence of high-energy impact:
• Falls:
• >=15 years: >20 ft = 2 stories = 6 m
• <15 years: >10 ft = 1 story = 3 m, or 2-3x the height of the child
• High-risk auto crash:
• Interior compartement intrusion, including roof:
• occupant site: >12 in = 30 cm
• any site: >18 in = 45 cm
• Ejection (partial or complete) from automobile
• Death in same passenger compartment
• Auto vs. pedestrian/bicyclist thrown, run over, or with >20 mph = >30 km/h
• Motorcycle crash >20 mph = 30 km/h
• -> Transport to closest appropriate trauma center which, depending on the defined trauma system, need not to be the highest level trauma center.
  
• Step 4: assess special patient or system considerations:
  
• Low impact mechanisms (e.g. ground level falls) might result in severe injury at age >55 years.
• Systolic blood pressure <110 mmHg represent shock at age >65 years.
• Patients with anticoagulation and bleeding disorders and with head injury are at high risk for rapid deterioration.
• Burns: patients with both burns and concomitant trauma for whom the burn injury poses the greatest risk for morbidity and mortality should be transferred to a burn center. If the nonburn trauma presents a greater immediate risk, the patient may be stabilized in a trauma center and then transferred to a burn center.
• Pregnancy >20 weeks
• EMS provider judgement
• -> Transport to a trauma center or hospital capable of timely and thorough evaluation and initial management of potentially serious injuries.
• When in doubt, transport to trauma center!