From the Guidelines
Patients with a Glasgow Coma Scale ≤13, systolic blood pressure <90 mmHg, respiratory rate of <10 or >29 breaths per minute, or need for ventilatory support qualify as a level 1 (P1) trauma.
Physiologic Criteria for P1 Trauma
The criteria for identifying P1 trauma are based on physiologic parameters that indicate severe injury and the need for immediate high-level trauma care. According to the guidelines for field triage of injured patients 1, the following criteria are used to identify patients who require transport to a facility that provides the highest level of care within the defined trauma system:
- Glasgow Coma Scale ≤13
- Systolic blood pressure <90 mmHg
- Respiratory rate of <10 or >29 breaths per minute (<20 in infant aged <1 year)
- Need for ventilatory support These criteria have been shown to have high predictive value for severe injury and the need for a high level of trauma care 1.
Importance of Early Identification and Intervention
Early identification and intervention are critical in P1 trauma patients, as the first hour after trauma (the "golden hour") is crucial for survival. Rapid intervention can directly impact mortality rates, and the P1 designation helps medical teams prioritize resources and ensure that the most critically injured patients receive immediate life-saving care. Treatment typically involves immediate airway management, hemorrhage control, fluid resuscitation, and often emergency surgery.
Activation of Trauma Team Response
P1 trauma activates the highest level of trauma team response in emergency departments, with immediate involvement of trauma surgeons, emergency physicians, anesthesiologists, and other specialists. This multidisciplinary approach ensures that patients receive comprehensive and timely care, which is essential for improving outcomes in P1 trauma patients. The guidelines for field triage of injured patients 1 provide a framework for identifying and managing P1 trauma patients, and adherence to these guidelines can help reduce morbidity and mortality in this critically injured population.
From the Research
Definition of Level 1 (P1) Trauma
- A level 1 trauma, also known as P1 trauma, is typically defined as a severe injury that requires immediate medical attention and has a high risk of mortality 2, 3.
- The determination of a level 1 trauma is often based on factors such as the mechanism of injury, anatomic involvement, and the patient's hemodynamic stability 4.
Characteristics of Level 1 Trauma
- Level 1 trauma often involves severe injuries such as penetrating abdominal and thoracic injuries, closed head injuries, and multiple trauma 4, 5.
- Patients with level 1 trauma may exhibit signs of hemodynamic instability, such as hypotension, tachycardia, and decreased peripheral circulation 2, 3.
- The Glasgow Coma Scale (GCS) is often used to assess the severity of head injuries and predict outcomes in trauma patients 2, 3.
Scoring Systems for Trauma
- Several scoring systems have been developed to predict mortality and outcomes in trauma patients, including the Revised Trauma Score (RTS) and the Mechanism of Injury, Glasgow Coma Scale, Age, and Systolic Blood Pressure (MGAP) scoring system 2, 3.
- These scoring systems take into account various factors such as the mechanism of injury, GCS, age, and systolic blood pressure to predict mortality and outcomes in trauma patients 2, 3.
Prehospital Care for Level 1 Trauma
- Prehospital care for level 1 trauma patients often involves rapid evacuation to a definitive care facility, with airway control and intravenous access provided en route 4, 5.
- The use of fluid resuscitation and other interventions in the prehospital setting is often guided by the patient's hemodynamic status and the mechanism of injury 4, 6.