From the Guidelines
Mechanisms of injury that qualify as level 1 (P1) trauma include high-energy impacts such as falls from heights greater than 20 feet, motor vehicle collisions with significant vehicle deformity or ejection of occupants, pedestrians struck by vehicles at speeds exceeding 20 mph, and penetrating injuries to the head, neck, chest, or abdomen. According to the guidelines for field triage of injured patients, recommendations of the national expert panel on field triage, 2011 1, these mechanisms are considered high-risk for severe injury or death.
Key Mechanisms of Injury
- Falls from heights greater than 20 feet for adults and greater than 10 feet or two to three times the height of the child for children
- High-risk auto crashes, including intrusion, ejection, or death in the same passenger compartment
- Pedestrians or bicyclists thrown, run over, or with significant impact
- Motorcycle crashes at speeds greater than 20 mph
- Vehicle telemetry data consistent with a high risk of injury
Physiological Criteria
In addition to these mechanisms, patients with severe physiological derangements, such as a Glasgow Coma Scale score of 13 or less, systolic blood pressure less than 90 mmHg, or respiratory rate less than 10 or greater than 29 breaths per minute, should also be considered P1 trauma 1.
Special Considerations
Special consideration should be given to older adults, children, patients with anticoagulants or bleeding disorders, and those with burns or pregnancy greater than 20 weeks, as these factors can increase the risk of severe injury or death 1.
Transport Protocol
When in doubt, transport to a trauma center, as early identification and intervention can significantly improve outcomes in P1 trauma patients 1.
From the Research
Mechanism of Injury for Level 1 (P1) Trauma
The mechanism of injury that qualifies as a level 1 (P1) trauma is not explicitly defined in the provided studies. However, the studies suggest that certain mechanisms of injury are associated with a high risk of severe trauma and multiple injuries.
- High-speed motor vehicle accidents, especially those involving side-impact crashes or frontal crashes with seat belt use, are associated with a high risk of severe blunt trauma and multiple injuries 2.
- Falls from a height, especially in older adults, can result in significant injuries, including intracranial and skeletal injuries 3.
- Penetrating injuries, such as those caused by knives or bullets, can also result in significant trauma 4.
- High-speed impact injuries in motor vehicle occupants, especially those who are unrestrained or ejected from the vehicle, can result in severe life-threatening injuries to the central nervous system, thoracic and abdominal viscera, and other areas 5.
Factors Influencing Injury Pattern and Severity
Several factors can influence the injury pattern and severity, including:
- Mechanism of injury: The type and severity of the injury can depend on the mechanism of injury, such as the direction of impact, speed, and use of safety devices 2, 5.
- Age: Older adults may be more susceptible to significant injuries from low-energy trauma, such as falls 3.
- Use of safety devices: The use of safety devices, such as seatbelts, can reduce the risk of severe injury in motor vehicle accidents 2.
- Preclinical factors: Preclinical factors, such as the patient's Glasgow Coma Scale (GCS) score, can influence the severity of injury and outcome 6.