# Trauma triage

A field-built guide to OCEMS trauma-triage criteria, including the decision pathway, age-specific vital-sign thresholds, significant injuries, mechanism criteria, special populations, base contact, and destination logic.

Official source: 310.30. Final implementation: April 1, 2024.
Population: Adult & pediatric. Scope: BLS / ALS / System.
Updated and source-checked: 2026-09-16.
Canonical page: https://www.ocmedic.com/reference/310-30-trauma-triage/

Independent OC Medic summary. This page does not replace the complete policy, current system notices, agency requirements, or clinical judgment.

## Base hospital contact is part of the trauma pathway

- Policy 310.30 applies to a person with blunt or penetrating injury. The presence of any listed abnormal vital sign, significant injury, or qualifying mechanism means the patient meets trauma-triage criteria.
- Base hospital contact is required for every patient described in the policy, and the base hospital determines the trauma destination.
- Treat immediate life threats and begin transport preparation while applying the criteria. Do not delay stabilization or movement to complete the screen in a rigid sequence.
- This guide summarizes the current official 310.30 policy and companion 310.31 algorithm. Use the linked source documents for controlling language.

## Trauma triage in one pass

- For a patient with blunt or penetrating injury, screen the four pathways below. A single qualifying finding is enough to move to base contact; multiple findings do not change the threshold.
- The first three pathways explicitly meet trauma-triage criteria. Provider judgment is a separate pathway to base contact when the field clinician believes trauma-center care would benefit the patient.

### OCEMS 310.30 / 310.31 decision pathway

1. **Any abnormal vital sign?** Mental status, respirations, oxygen saturation, systolic blood pressure, or heart-rate criterion. **Yes:** Base contact. Patient meets trauma-triage criteria. **No:** Continue to significant injuries.
2. **Any significant injury?** One listed anatomic, neurologic, hemorrhage, pregnancy, or bleeding-risk finding. **Yes:** Base contact. Patient meets trauma-triage criteria. **No:** Continue to mechanism.
3. **Any qualifying mechanism?** One listed fall, auto, pedestrian, hanging, dive, or unenclosed-vehicle mechanism. **Yes:** Base contact. Patient meets trauma-triage criteria. **No:** Apply EMS provider judgment.
4. **Would trauma-center care benefit the patient?** Paramedic or EMT judgment at the scene supports trauma-center transport. **Yes:** Contact the base hospital for destination. **No:** The patient does not meet an above pathway.
- **No pathway applies:** Transport to an appropriate Emergency Receiving Center under the companion algorithm.

*A yes in the first three rows means the patient meets trauma-triage criteria. Destination is still determined through base-hospital contact.*

## Immediate field workflow

1. Manage airway, ventilation, oxygenation, major hemorrhage, shock, and other immediate threats while rapidly identifying the injury pattern.
2. Check for any qualifying abnormal vital sign, then any significant injury, then any qualifying mechanism. Apply provider judgment even when no listed criterion is present.
3. When a pathway applies, contact the base hospital and state the actual trigger or triggers rather than reporting only that the patient meets trauma criteria.
4. Follow the base-directed destination. Continue reassessment, treatment, and transport preparation; report deterioration or a newly recognized criterion.
5. If none of the four pathways applies, use the companion algorithm's direction to transport to an appropriate Emergency Receiving Center.

## Abnormal vital-sign criteria

- Any one finding in this table meets trauma-triage criteria after blunt or penetrating injury.
- Use the patient's age at the time of assessment. The policy uses different age bands for systolic pressure, heart rate, pediatric falls, and restraint status.

| Assessment | Trauma-triage threshold | Field interpretation |
| --- | --- | --- |
| Mental status | Unable to follow commands with an acute decrease from usual mental status; motor GCS less than 6 | Confirm that the finding is acute; report the motor response and usual baseline. |
| Respiratory rate | Less than 10 or greater than 29 breaths/min | Either extreme qualifies. |
| Respiratory status | Respiratory distress or need for respiratory support | This is an independent respiratory trigger even if the numeric rate is within range. |
| Oxygen saturation | Room-air pulse oximetry less than 90% | Record that the value was obtained on room air when feasible and do not withhold needed oxygen to reproduce it. |
| SBP, age 0-9 | Less than 70 mmHg + (2 × age in years) | Use the age-based pediatric threshold. |
| SBP, age 10-64 | Less than 90 mmHg | One systolic value below the threshold qualifies; trend and reassess. |
| SBP, age 65 or older | Less than 110 mmHg | The older-adult threshold is intentionally higher. |
| Heart rate, age 10 or older | Heart rate greater than systolic blood pressure | Compare the two numeric values; report both. |

## Significant injury criteria

- Any one listed injury meets trauma-triage criteria. Examine exposed regions as clinically appropriate; do not let a dramatic mechanism substitute for the actual injury assessment.
- For penetrating injuries, the policy uses the phrase appears to penetrate all skin layers.

| Region / concern | Qualifying finding |
| --- | --- |
| Head | Penetrating or open head injury; depressed skull fracture; or blunt/penetrating head injury with observed loss of consciousness, focal neurologic deficit, asymmetric pupils, or vomiting. |
| Neck / torso | Penetrating injury appearing to pass through all skin layers of the neck, chest, abdomen, back, or groin. |
| Spine | Suspected spinal injury with new motor or sensory loss. |
| Chest | Blunt chest injury with abnormal respiration as defined in the vital-sign criteria. |
| Seat-belt sign | Seat-belt bruising or abrasion of the neck, chest, or abdomen. |
| Abdomen / flank | Blunt abdominal or flank injury with palpable tenderness. |
| Long bones / pelvis | Fracture of two or more long bones - femur or humerus - or pelvic-rim pain or deformity on palpation. |
| Extremity penetration / perfusion | Penetration through all skin layers above the elbow or knee, or an extremity injury with poor circulation or no pulse. |
| Amputation / severe extremity injury | Partial or complete amputation above the wrist or ankle, or a crushed, degloved, or mangled extremity excluding only fingers or toes. |
| Pregnancy | Reported or obviously pregnant patient with blunt or penetrating abdominal injury. |
| Hemorrhage control | Active bleeding requiring a tourniquet or wound packing with continuous pressure. |
| Head injury plus bleeding risk | Blunt head injury with bruising at the injury site plus known anticoagulant or platelet-inhibitor use excluding aspirin, or known hemophilia, or dialysis. |

## Mechanism-of-injury criteria

- Any one listed mechanism meets trauma-triage criteria. The policy says heights, speeds, and distances are best estimates; document how the estimate was obtained when possible.
- For this section, the policy defines a child as younger than 15 years.

| Mechanism | Qualifying detail |
| --- | --- |
| Fall - adult / adolescent | Greater than 10 feet; the policy equates one story with 10 feet. |
| Fall - child under 15 | Greater than 10 feet or 2-3 times the child's height. |
| Fall from horse | Fall from a galloping horse at any age. |
| Passenger-space intrusion | Greater than 12 inches where the trauma victim sits, or greater than 18 inches at any site in the passenger space. |
| Ejection | Partial or complete ejection from an automobile. |
| Extrication | Passenger requiring extrication. |
| Child restraint | Passenger age 0-9 who is unrestrained. |
| Death in compartment | Person in the same passenger compartment in which a trauma death occurred. |
| Dive / shore break | Dive or shore-break injury with suspected spinal-cord injury. |
| Hanging | Hanging. |
| Auto vs pedestrian / bicyclist | Thrown any distance, run over, or significant impact greater than 20 mph. |
| Unenclosed motorized vehicle | Crash greater than 20 mph involving a motorcycle, bike, scooter, or similar vehicle, including laying the bike down. |

## Age and special-population checks

- Children younger than 15 use the pediatric fall rule; only ages 0-9 use the age-based systolic-pressure formula and the unrestrained-passenger mechanism criterion.
- Patients age 65 or older meet the systolic-pressure criterion below 110 mmHg. Do not apply the age 10-64 threshold to this group.
- For reported or obvious pregnancy, blunt or penetrating abdominal injury is a significant-injury criterion.
- For blunt head injury, the bleeding-risk pathway requires bruising at the injury site plus anticoagulant or platelet-inhibitor use excluding aspirin, hemophilia, or dialysis. Aspirin alone is specifically excluded from this listed trigger.
- Baseline cognitive or neurologic impairment does not by itself satisfy the mental-status trigger; the policy specifies an acute decrease from the patient's usual status.

## 15 blood thinners and antiplatelets to recognize

- Use this as a name-recognition aid, not an exhaustive medication list or a frequency ranking. Ask the patient, family, pharmacy, or facility to confirm the medication, and inspect the bottle or medication record when available.
- For the specific 310.30 bleeding-risk criterion, the complete finding is blunt head injury with bruising at the injury site plus known anticoagulant or platelet-inhibitor use. Aspirin alone is expressly excluded from that criterion; another trauma criterion or provider judgment may still apply.
- Patients may report a brand name after receiving a generic product, and combination products may be shortened in conversation. Record the name actually reported and the source of the medication history.

| Class | Generic name | Brand / commonly reported name |
| --- | --- | --- |
| Anticoagulant - factor Xa inhibitor | Apixaban | Eliquis |
| Anticoagulant - factor Xa inhibitor | Rivaroxaban | Xarelto |
| Anticoagulant - direct thrombin inhibitor | Dabigatran | Pradaxa |
| Anticoagulant - factor Xa inhibitor | Edoxaban | Savaysa |
| Anticoagulant - vitamin K antagonist | Warfarin | Coumadin / Jantoven |
| Anticoagulant - low-molecular-weight heparin | Enoxaparin | Lovenox |
| Anticoagulant - low-molecular-weight heparin | Dalteparin | Fragmin |
| Anticoagulant - factor Xa inhibitor | Fondaparinux | Arixtra |
| Anticoagulant - unfractionated heparin | Heparin | Usually labeled heparin sodium; commonly generic |
| Antiplatelet - P2Y12 inhibitor | Clopidogrel | Plavix |
| Antiplatelet - P2Y12 inhibitor | Ticagrelor | Brilinta |
| Antiplatelet - P2Y12 inhibitor | Prasugrel | Effient |
| Antiplatelet | Aspirin | Bayer Aspirin / Ecotrin - excluded alone under this 310.30 criterion |
| Antiplatelet combination | Aspirin + extended-release dipyridamole | Aggrenox |
| Antiplatelet / vasodilator | Cilostazol | Pletal |

- [MedlinePlus drug information index](https://medlineplus.gov/druginformation.html)
- [MedlinePlus antiplatelet overview](https://medlineplus.gov/ency/patientinstructions/000100.htm)

## Provider judgment and traumatic arrest

- If a paramedic or EMT judges at the scene that an injury patient would benefit from trauma-center transport, contact the base hospital for destination even when no listed vital-sign, injury, or mechanism criterion is present.
- For a traumatic respiratory or cardiopulmonary arrest in which resuscitation and transport are pursued, triage is at the base-hospital physician's discretion.
- Policy 310.30 directs both an unmanageable airway and traumatic cardiopulmonary arrest to a trauma center when the base physician elects resuscitation and transport.

## Base contact and destination

1. Identify the patient as blunt or penetrating trauma and give the exact criterion or criteria met: vital sign, significant injury, mechanism, or provider-judgment concern.
2. Report age, mental status and motor GCS when relevant, respiratory status, room-air saturation when available, blood pressure, heart rate, major injuries, hemorrhage-control measures, trend, and response to treatment.
3. For mechanism triggers, include estimated height, speed, intrusion location and depth, ejection, extrication, restraint status, death in the compartment, or other applicable detail.
4. Request or confirm the destination through the base hospital. A center's presence on the designation list does not establish real-time acceptance, diversion, or specialty availability.
5. Keep the base updated when physiology worsens, new injuries emerge, the airway becomes unmanageable, or transport circumstances materially change.

- [Open the current trauma receiving-center guide](/reference/240-10-list-of-trauma-receiving-centers/)

## Current trauma receiving centers

- Policy 240.10, effective January 1, 2026, lists five trauma receiving centers. Use this as a designation reference only; the base hospital determines the operational destination under 310.30.

| Trauma receiving center | Designation note |
| --- | --- |
| Rady Children's Hospital Orange County | Pediatric trauma center |
| Orange County Global Medical Center | Orange County trauma center |
| Mission Hospital - Mission Viejo | Orange County trauma center |
| UCI Health - Orange | Orange County trauma center |
| Long Beach Memorial Medical Center | Los Angeles County EMS designation |

## Documentation and handoff

- Record the specific trauma-triage trigger, not only a conclusion such as trauma patient or trauma activation.
- Preserve serial vital signs, GCS components when abnormal, oxygen conditions, distal perfusion, neurologic findings, exposed injury findings, hemorrhage-control interventions, and treatment response.
- For mechanism criteria, record the best available estimate and source - patient, witness, scene evidence, or public-safety report - without converting uncertainty into false precision.
- Document base-hospital contact time, physician or MICN direction as applicable, assigned destination, significant updates, and any reason the planned destination or transport mode changed.
- At handoff, restate the exact qualifying findings and trends so the receiving team can distinguish physiology, anatomic injury, mechanism, and clinician concern.

- [Open the companion Trauma Triage Algorithm - 310.31](/reference/310-31-trauma-triage-algorithm/)
- [Open the trauma receiving-center guide - 240.10](/reference/240-10-list-of-trauma-receiving-centers/)

## Official OCEMS sources

- [310.30 - Trauma Triage](https://www.ochealthinfo.com/sites/healthcare/files/2024-05/310.30%20Trauma%20Triage%20%285-24%29.pdf)
- [310.31 - Trauma Triage Algorithm](https://www.ochealthinfo.com/sites/healthcare/files/2024-05/310.31%20Trauma%20Triage%20Algorithm%20%285-24%29.pdf)
- [240.10 - List of Trauma Receiving Centers](https://www.ochealthinfo.com/sites/healthcare/files/2026-01/240.10%20List%20of%20Trauma%20Centers%20%2812-2025%29.pdf)

[OCEMS notices and system updates](https://www.ochealthinfo.com/providers-partners/emergency-medical-services)