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 summary · Final implementation April 1, 2024 · Updated 2026-09-16
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.
Would trauma-center care benefit the patient?Paramedic or EMT judgment at the scene supports trauma-center transport.
YESContact the base hospital for destination.
NOThe patient does not meet an above pathway.
No pathway appliesTransport 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
Manage airway, ventilation, oxygenation, major hemorrhage, shock, and other immediate threats while rapidly identifying the injury pattern.
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.
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.
Follow the base-directed destination. Continue reassessment, treatment, and transport preparation; report deterioration or a newly recognized criterion.
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
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
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.
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.
For mechanism triggers, include estimated height, speed, intrusion location and depth, ejection, extrication, restraint status, death in the compartment, or other applicable detail.
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.
Keep the base updated when physiology worsens, new injuries emerge, the airway becomes unmanageable, or transport circumstances materially change.
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.
