64J-2.004. Adult Trauma Scorecard Methodology

(1) Each EMS provider shall ensure that upon arrival at the location of an incident, an EMT or paramedic shall:

(a) Assess the condition of each adult trauma patient using the adult trauma scorecard methodology, as provided in this section, to determine whether the patient should be a trauma alert.

(b) In assessing the condition of each adult trauma patient, the EMT or paramedic shall evaluate the patient’s status for each of the following components: airway, circulation, best motor response (a component of the Glasgow Coma Scale which is defined and incorporated by reference in subsection 64J-2.001(6), F.A.C.), cutaneous, longbone fracture, patient’s age, and mechanism of injury. The patient’s age and mechanism of injury shall only be assessment factors when used in conjunction with assessment criteria included in subsection (3) of this section.

(2) The EMT or paramedic shall assess all adult trauma patients using the following criteria in the order presented and if any one of the following conditions are identified, the patient shall be considered a trauma alert patient:

(a) Airway: The patient receives active airway assistance beyond the administration of oxygen.

(b) Circulation: The patient lacks a radial pulse with a sustained heart rate greater than 120 beats per minute or has a blood pressure of less than 90 mmHg.

(c) Best Motor Response (BMR): The patient exhibits a score of four or less on the motor assessment component of the Glasgow Coma Scale, or exhibits the presence of paralysis or there is the suspicion of a spinal cord injury or the loss of sensation.

(d) Cutaneous: The patient has 2nd or 3rd degree burns to 15 percent or more of the total body surface area, or amputation proximal to the wrist or ankle, or any penetrating injury to the head, neck, or torso (excluding superficial wounds where the depth of the wound can be determined).

(e) Fracture: The patient reveals signs or symptoms of two or more long bone fracture sites (humerus, (radius, ulna), femure, (tibia or fibula)).

(3) Should the patient not be identified as a trauma alert using the criteria listed in subsection (2) of this section, the trauma patient shall be further assessed using the criteria in subsection (3) of this section and shall be considered a trauma alert patient when a condition is identified from any two of the seven components included in this section.

(a) Airway: The patient has a respiratory rate of 30 or greater.

(b) Circulation: The patient has a sustained heart rate of 120 beats per minute or greater.

(c) BMR: The patient has a BMR of 5 on the motor component of the Glasgow Coma Scale.

(d) Cutaneous: The patient has a soft tissue loss from either a major degloving injury, or a major flap avulsion greater than 5 inches, or has sustained a gun shot wound to the extremities of the body.

(e) Longbone Fracture: The patient reveals signs or symptoms of a single longbone fracture resulting from a motor vehicle collision or a fall from an elevation of 10 feet or greater.

(f) Age: The patient is 55 years of age or older.

(g) Mechanism of Injury: The patient has been ejected from a motor vehicle (excluding any motorcycle, moped, all terrain vehicle, bicycle or the open body of a pick-up truck), or the driver of the motor vehicle has impacted with the steering wheel causing steering wheel deformity.

(4) If the patient is not identified as a trauma alert patient after evaluating the patient using the criteria in subsections (2) and (3) of this section, the trauma patient will be evaluated using all elements of the Glasgow Coma Scale. If the patient’s score is 12 or less, the patient shall be considered a trauma alert patient (excluding patients whose normal Glasgow Coma Scale Score is 12 or less, as established by the patient’s medical history or preexisting medical condition when known).

(5) Where additional local trauma alert criteria has been approved by the medical director of the EMS service and presented as part of the state TTP approval process, the use of local trauma alert criteria as the basis for calling a trauma alert shall be documented in the patient care record in accordance with the requirements of in Rule 64J-1.014, F.A.C. Local trauma assessment criteria can only be applied after the patient has been assessed as provided in subsections (2), (3), and (4) of this section.

(6) In the event that none of the conditions are identified using the criteria in subsections (2), (3), (4), or (5) of this section in the assessment of the adult trauma patient, the EMT or paramedic can call a trauma alert if, in his or her judgment, the patient’s condition warrants such action. Where EMT or paramedic judgment is used as the basis for calling a trauma alert, it shall be documented in the patient care record in accordance with the requirements of Rule 64J-1.014, F.A.C.

(7) The results of the patient assessment shall be recorded and reported in the patient care record in accordance with the requirements of Rule 64J-1.014, F.A.C.

Rulemaking Authority 395.4045, 395.405, 401.35 FS. Law Implemented 395.401, 395.4015, 395.402, 395.4025, 395.4045, 395.405, 401.30, 401.35 FS. History–New 8-3-88, Amended 12-10-92, 11-30-93, Formerly 10D-66.102, Amended 11-4-99, 2-20-00, Formerly 64E-2.017, Amended 11-5-09.