Step One: Physiology
Altered mental status, hypotension, abnormal respiratory rate, and a low GCS are high-priority criteria. These findings reflect the patient's current instability. Meeting any physiologic criterion typically calls for the highest-level trauma center.
Step Two: Anatomy
Penetrating injuries to the head, neck, torso, or proximal extremities, flail chest, unstable pelvis, and paralysis warrant trauma center transport. Amputations proximal to the wrist or ankle and open skull fractures are also included. These injuries carry high risk of death.
Mechanism and Special Populations
Significant mechanisms include high-speed crashes, falls from heights, ejection, and pedestrians struck by vehicles. Older adults, children, pregnant patients, and those on anticoagulants may deserve a lower threshold for transport. When in doubt, contact medical direction.