American College of Surgeons (ACS) Trauma Triage Guidelines Update Published by the CDC

New trauma triage guidelines have been published by the CDC.


In January, 2012 a publication by the Centers For Disease Control Morbidity and Mortality Weekly Reports updated the “Guidelines for Field Triage of Injured Patients recommendations of the national expert panel of field triage, 2011".  This is a revised addition of the ACS Triage guidelines.  The American College of Surgeons (or ACS) guidelines have been published since 1986 with further updates in 1990, 1993 and 1999.  Using funds from the National Highway Traffic Safety Commission, the CDC collaborated with the ACS to publish a further revision in 2006.  The guidelines have used 4 steps; any one of them can prompt the EMT personnel to transfer.  The first step is the “Physiologic Criteria”. This step measures the Glasgow Coma Scale as well as Blood Pressure and Respiration Rate.  The next step is “Anatomic Criteria”.  This states that any severe injury such as flail chest or penetrating wounds can be enough criteria to require transfer even without positive Physiologic Criteria.   The next step is Mechanism of Injury Criteria.  For example, the mechanism of a fall would be criteria alone (even without any evidence of criteria from the first two steps) if the height of the fall is greater than 20 feet. The final step is Special Considerations. This step takes into account any predisposing medical conditions or age. 

The revisions to the 2006 update that were published in 2011 are the following:

 Step One: Physiologic Criteria

• Change GCS <14 to GCS ≤13

• Add “or need for ventilatory support” to respiratory criteria

Step Two: Anatomic Criteria

• Change “all penetrating injuries to head, neck, torso and extremities proximal to elbow and

knee” to “all penetrating injuries to head, neck, torso and extremities proximal to elbow or knee”

• Change “flail chest” to “chest wall instability or deformity (e.g., flail chest)”

• Change “crushed, degloved, or mangled extremity” to “crushed, degloved, mangled, or

                pulseless extremity”

• Change “amputation proximal to wrist and ankle” to “amputation proximal to wrist or ankle”

Step Three: Mechanism-of-Injury Criteria

• Add “including roof” to intrusion criterion

Step Four: Special Considerations

• Add the following to older adult criteria

— SBP <110 might represent shock after age 65 years

— Low-impact mechanisms (e.g., ground-level falls) might result in severe injury

• Add “patients with head injury are at high risk for rapid deterioration” to anticoagulation and

bleeding disorders criterion

• Remove “end-stage renal disease requiring dialysis” and “time-sensitive extremity injury”

Transition Boxes

• Change layout of the figure

• Modify specific language of the transition boxes


Abbreviation: GCS = Gasgow Coma Scale; SBP = systolic blood pressure.        

These changes improve the Triage Criteria and provide further guidelines for the care of the trauma patient.


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