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ABSTRACT
The use of trauma field triage criteria is designed to match a patient's injury type and severity to prioritized transport and an institution with the resources to provide timely, definitive care. Triage schemes used in austere environments created by war or mass casualty events are less applicable to day-to-day civilian trauma. Civilian triage criteria, developed and refined over the past 25 years, rely on physiologic, anatomic, and mechanistic indicators of severe injury in an attempt to optimize overtriage and undertriage. As organized trauma systems continue to mature, the need for more accurate direction of high- versus low-acuity patients to regional centers, stratified by their capabilities, becomes more apparent and is essential in avoiding a completely 'exclusive' trauma system. New technology utilizing vehicular telemetry and Web-based information systems may simplify the seemingly simple but often formidable task of creating destination decision rules for victims of major injury. Key words: triage; trauma centers; injuries.
PREHOSPITAL EMERGENCY CARE 2006;10:287-294
INTRODUCTION
The care of injured patients requires special resources, regardless of the era or situation. This is particularly so with larger numbers and/or more severe injuries. Historically in the battlefield environment, where much of our knowledge of trauma was accrued, resources were scarce and the injured, many. The need for prioritization of care based on injury type and severity coupled with the measured use of these scarce resources was necessary to derive the greatest survival benefit for large numbers of casualties. This prioritization depended on an in-field system that allowed the stratification or sorting (triage, French) of battle wounded to immediate versus delayed (or expectant) care. Early historical records are sketchy in terms of the origins of battle "triage," but the earliest use of this technique is generally credited to Baron Dominique Jean Larrey who, in addition to developing the first field ambulance (ambulance volante) in the late 1700s, also espoused the notion that "Those who are dangerously wounded should receive the first attention, without regard to rank or distinction."
Subsequent wars, often in their own unique way, spurred the development of field triage criteria. During the Civil War, a rudimentary ad hoc scheme for immediate treatment (e.g., gunshot wound to extremity) versus delayed treatment (walking wounded) versus "expectant" or no treatment (e.g., gunshot wound to...