Virginia Trauma Triage Decision Scheme
Posted by Bryan Hodges, Last modified by Bryan Hodges on 22 June 2020 01:17 PM

The attached PDF illustrates the Virginia Trauma Triage Decision Scheme. The Virginia scheme was developed by members of the Emergency Medical Service Advisory Board’s (EMS Advisory Board) TSO&MC with input from the Medical Direction Committee. The CDC Field Triage Decision Scheme: The National Trauma Triage Protocol was utilized as the basis for the development of the Virginia scheme.

The Virginia scheme differs from the CDC scheme in two ways.  First, Steps One and Two replace the term “transported preferentially to the highest level of care within the trauma system” with “transported preferentially to a Level I and Level II trauma center.” Level I and Level II trauma centers are the highest level of trauma care in Virginia. The second difference is between Steps Three and Four. The CDC language that states; “transport to the closest appropriate trauma center” was changed to “transport to the closest appropriate hospital.” This was done to accommodate for the fact that the CDC document was created with consideration for systems that have Level IV and Level V trauma centers, which Virginia does not have.

Note: Prehospital providers should transfer trauma patients with uncontrolled airway, uncontrolled hemorrhage, or if there is CPR in progress to the closest hospital for stabilization and transfer.

The Medical Direction Committee of the EMS Advisory Board requested that the following statement from page 23 of the CDC’s Guidelines for Field Triage of Injured Patients; Recommendations of the National Expert Panel on Field Triage be included in this document:

Transition from Step Three to Step Four of Field Trauma Triage Decision Scheme: The answer of "yes" at Step Three of the Decision Scheme mandates transport of the patient to the closest appropriate trauma center, not necessarily to a center offering the highest level of trauma care available, as is the case in Steps One and Two. Which center is the most appropriate at any given time will depend on multiple factors, including the level of trauma center readily available, the configuration of the local or regional trauma system, local EMS protocols, EMS system capacity and capability, transport distances and times, and hospital capability and capacity. Patients whose injuries meet mechanism-of-injury criteria but not physiologic or anatomic criteria do not necessarily require the highest level of care available. At the time of evaluation, these patients are hemodynamically stable, have a GCS of >14, and have no anatomic evidence of severe injury. Their risk lies only in the mechanism by which they were injured. Thus, they require evaluation but do not need immediate transport by EMS providers to a Level I or Level II facility. If a severe injury is identified at the initial hospital evaluation, these patients may be transferred subsequently to a higher level of trauma care. For patients who do not meet Step Three criteria, the EMS provider should proceed to Step Four of the Scheme (Centers for Disease Control and Injury Prevention, 2009, p. 23).

To review the above information, the evidence supporting the guideline and other detailed information about the rationale for field trauma triage the reader is referred to the document “Guidelines for Field Triage of Injured Patients, Recommendations of the National Expert Panel of Field Triage.” The document was released by the Centers for Disease Control and Injury Prevention via the Morbidity and Mortality Weekly Report (MMWR) on January 23, 2009 / Vol. 58 / No. RR-1. This report and other resource materials are available on-line at

 Virginia Triage Decision Scheme.pdf (415.22 KB)
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