South Wales Major Trauma Triage Tool

Applies to South Wales, West Wales and South Powys (v2.5SM/GL) Apply this triage tool to all patients suspected to have suffered major trauma

Yes to ANY of the below criteria - contact the trauma desk on 0300####### talk group 442 Any patient with airway compromise or catastrophic haemorrhage – Pre-alert to nearest Emergency Department

2. Assess Anatomy of Injury 3. Assess Mechanism of 4. Special considerations. 1.Measure vital signs. Injury. Penetrating injuries if shocked or (Use JRCALC abnormal values for requiring haemorrhage control Falls. Older Adults. children)  Adult > 20 feet (6 metres)  If over 65 complete the Silver Significant chest wall trauma.  Child >10 feet (or 2 x height of Trauma Triage Tool (see Respiratory rate. (e.g. Deformity, flail Chest). child). reverse).  <10 or >29 breaths per minute. Two or more proximal long bone Children Systolic Blood. High mechanism RTC. fractures (i.e femur, tibia and humeral  Higher potential for injury.  Sustained Systolic Blood Pressure  Significant cabin intrusion. shaft-not neck of femur/humerus)  Ejection (partial or complete) from <90 mmHg or absent radial Any clinical concern pulses. Crushed/ De-gloved/ mangled/ motor vehicle.  Death in same passenger pulseless limbs. Anticoagulation and Bleeding Glasgow Coma Score. compartment. Disorders  Motor score 4 (flexing to pain) or Amputation above wrist or ankle.  Available information consistent with high risk of injury.  Patients on anticoagulation less. medication (e.g. Warfarin, Suspected Major Pelvic fractures.  Motor Vehicle vs Pedestrian or Apixaban Rivaroxaban) are at a (If active bleeding is suspected from a cyclist > 20mph. higher risk and need discussion pelvic fracture following blunt high-energy  Motorcycle crash > 20 mph. with trauma desk trauma)  Head injuries are particularly at Non motor vehicle incident Open or depressed skull fractures. risk. Major Burns Base of Skull fractures.  Large animal incident (collision/fall/trampled) Pregnancy > 20 weeks NO Spinal trauma suggested by new, NO NO abnormal neurology.

No to all above criteria – Convey to nearest Trauma Unit (Local guidelines in Hywel Dda UHB)

Patients ≥65 must have a Silver Trauma Triage Tool assessment

A TTime of M I SSigns and TTreatment Age and sex Mechanism Injuries Incident Symptoms Given

Silver Trauma Triage Tool Major Trauma Centre University Hospital for Wales Cardiff CF 14 4XW Criteria: 1. Patients suspected of suffering major trauma Trauma Units 2. Patients who have had the major trauma tool applied and are negative Glangwili Hospital Carmarthen SA31 2 AF 3. Patients over 65 years of age Morriston Hospital Swansea-SA6 6NL Neville Hall Hospital-NP7 7EG

Princess of Wales Bridgend- CF311RQ

Prince Charles Hospital Merthyr-CF479DT Yes to any of the below then contact the Trauma Desk Clinician on 0330xxxxxx Royal Gwent Hospital Newport-NP20 2UB

(The Grange Hospital NP44 2XJ will become the Physiology Anatomy Mechanism Trauma Unit for Aneurin Bevan health board once completed) Sustained SBP <110mmHg Injury to 2 or more body areas Fall down 3 or more steps in the presence of injury (excluding injuries distal Tranexamic acid should be administered as soon as Pedestrian vs car/cycle (excluding minor injuries) wrist/ankles) possible following trauma, ideally within the first Caution:Older adults with hour. Anticoagulant medication in Suspected fracture to shaft of frailty: low level falls (ground the presence of injury femur The indications for Tranexamic: level) might result in severe  For all patients aged ≥1 with Time Critical injury Open fracture to wrist or ankle injury, especially alongside degenerative conditions where significant internal/external haemorrhage is suspected.  Traumatic cardiac arrest