外傷患者・現場トリアージガイドライン

Guidelines for Field Triage of Injured Patients
Recommendations of the National Expert Panel on Field Triage, 2011
Recommendations and ReportsJanuary 13, 2012 / 61(RR01);1-20
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr6101a1.htm?s_cid=rr6101a1_w


Emergency Medical Services (EMS) 担当者の病院搬送に関わる、現場トリアージ（"field triage"）

外傷の生理・解剖だけで無く、メカニズム・個別的考察が必要。


要約：
Training Guide for Emergency Medical Services Leaders
http://www.cdc.gov/FieldTriage/pdf/EMS_Guide-a.pdf


CDC:Injury Prevention & Control: Field Triage

BOX 2. Changes in 2011 Guidelines for Field Triage of Injured Patients compared with 2006 guidelines

Step One: Physiologic Criteria

• Change GCS ＜4 to GCS ≤13
• Add "or need for ventilatory support" to respiratory criteria

Step Two: Anatomic Criteria

• Change "all penetrating injuries to head, neck, torso and extremities proximal to elbow and knee" to "all penetrating injuries to head, neck, torso and extremities proximal to elbow or knee"
• Change "flail chest" to "chest wall instability or deformity (e.g., flail chest)"
• Change "crushed, degloved, or mangled extremity" to "crushed, degloved, mangled, or pulseless extremity"
• Change "amputation proximal to wrist and ankle" to "amputation proximal to wrist or ankle"

Step Three: Mechanism-of-Injury Criteria

• Add "including roof" to intrusion criterion

Step Four: Special Considerations

• Add the following to older adult criteria
  • SBP ＜110 might represent shock after age 65 years
  • Low-impact mechanisms (e.g., ground-level falls) might result in severe injury

• Add "patients with head injury are at high risk for rapid deterioration" to anticoagulation and bleeding disorders criterion
• Remove "end-stage renal disease requiring dialysis" and "time-sensitive extremity injury"

Transition Boxes

• Change layout of the figure
• Modify specific language of the transition boxes

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Abbreviation: GCS = Gasgow Coma Scale; SBP = systolic blood pressure.