Trauma Triage: New York Experience

Abstract

New York State developed a statewide trauma program in the early 1990s. Designation of trauma centers andprehospital triage of patients by emergency medical services are pillars of the system. Outcomes are evaluated as part of the quality improvement system. New York has a statewide trauma registry with population-based data for all of the state but New York City. Studies made possible because of the trauma registry provided evidence to guide revision of the emergency medical services trauma triage protocol for adult patients. For example, pulse < 50 or > 120 beats/min was retained as a physiologic criteria, while crumple zone andcrash speed were eliminated as mechanism criteria. Patients with certain physiologic criteria treated in regional centers showed a considerably reduced mortality rate when compared with patients treated in area trauma centers andnoncenters. Other “high-risk” populations were identified for special consideration by emergency medical technicians for trauma center transport because of their associated higher mortality. One “high-risk” group, patients older than 55 years or younger than 5 years, has associated 11% mortality (compare with a statewide average of 7.43%) andrepresents 41% of all registry patients. Population-based trauma registries andstructured prehospital trauma records that accurately record the presence or absence of trauma criteria are essential to evaluate trauma triage criteria; improve quality, efficiency, andaccess; andguide care.