This week’s CDC Morbidity and Mortality Weekly Report provides the guidelines that approximately 800,000 emergency medical service (EMS) providers should use to have a substantial impact on the care and survival of injured persons.
Injury is the leading cause of death for persons aged 1 through 44 years. And the lifetime medical costs of injuries that occurred in 2000 (the most recent year for which numbers are available), are estimated to be about $80.2 billion. So minimizing injury is good, not only for the patient, but for the nation.
This “Guideline for Field Triage of Injured Patients,” revised from earlier versions in 2006 with the help of national experts in EMS, offers consumers some interesting information about injury treatment they may want to know before they need the services.
In the field, emergency medical service (EMS) providers will determine the severity of an injury, initiate treatment and identify the best place to bring you. A trauma center can be found in some hospitals providing care above the emergency room. Trauma centers are classified from Level I to Level IV.
Level I- centers providing the highest level of trauma care. The risk of death is reported to be about 25 percent lower if a severely injured patient is taken to a Level I center, however not all patients should automatically be taken to a level I facility because it may overburden the personnel.
Level IV – centers that provide initial care that can transfer you to a higher level if necessary.
A trauma center is an acute-care facility that has resources and personnel to care for severely injured patients. A 24-hour emergency department, access to surgeons, anesthesiologists, other specialists, nurses, and resuscitation and life support equipment should all be present.
The different levels of trauma center do not imply a different quality of care rendered, rather the level of resources. A level V center may be located in a remote rural setting in which a higher level of care is not available, but may have a nurse practitioner or physician’s assistant trained in trauma resuscitation.
EMS providers work in approximately 15,000 different systems across the US and provide nearly 16.6 million transport calls per year. About 6.5 million are attributed to injury. EMS providers are regulated by their various states however all must operate under the license and direction of one or more licensed physicians.
Rating Scale for Injury
Worldwide the most accepted injury severity scale is the Abbreviated Injury Scale (AIS), which ranks each injury in every body region with a numerical score (one being a minor injury, 6 a probable lethal injury).
Another way of communicating injury is the Injury Severity Score (ISS), which takes into account multiple injuries. It uses a scale of 1-75) which is assigned to each of six body regions (head/neck; face; thorax; abdomen/visceral pelvis; bony pelvis/extremities; and external structures). A patient coming into a trauma center may have an AIS score of 6 and an ISS score of 75.
ISS has been used to predict mortality and risk for possible organ failure.
The importance of making accurate decisions in the field and relaying them to an emergency or trauma center can make the difference between life and death. Patients treated at Level I trauma centers had lower hospital mortality, fewer deaths at 30 days after injury and fewer deaths 90 days after injury.
Addressing injuries beginning in the field not only saves lives but improves the national picture. The cost of injury in the US exceeded $400 billion in 2000. The 50 million people who were taken to an emergency department in 2000, were associated with $80 billion in medical costs, and an estimated $326 billion in productivity loss.
The best way to reduce the harm from injuries is to prevent them in the first place. However when injury prevention fails, the revised 2006 Decision Scheme is meant to assist EMS workers in making the right critical decision to save your life. #