Trauma Tree

Select a workflow to begin.

Primary Workflow

Trauma Code Dashboard

Full ATLS-based trauma activation workflow. Systematic assessment from triage through primary survey (ABCDE), secondary survey, imaging, disposition, and consulting services.

Admission Pathway

Trauma Service Admission Decision Tree

Determine the appropriate admitting service based on mechanism, injury pattern, and hospital protocols.

Transfer Pathway

Transfer to Higher Level Trauma Center

MTAC regional transfer criteria for adult and pediatric trauma patients. Determine if patient injuries exceed facility capabilities and require transfer.

Trauma/ED Hospitalization Decision Tree

Determine the appropriate admitting service based on mechanism, injury pattern, and hospital protocols. Based on the Trauma/ED Hospitalization Decision Tree (2-15-2024).

STEP 1 What is the primary reason this patient needs hospitalization?

Select the option that best describes why this injured patient requires admission. This determines the admitting service.

Transfer to Higher Level Trauma Center

MTAC Regional Transfer Criteria and Management Guidelines. Does not replace clinical judgement — when unsure, call for consult.

STEP 1 Patient population

Triage

ATLS-based triage assessment. Mechanism of injury, initial vitals, and field triage criteria.

ATLS 10-Second Assessment

Introduce yourself. Ask the patient their name and what happened. An appropriate verbal response confirms: airway is patent (can speak clearly), breathing is not severely compromised (generating air movement), and consciousness is not markedly decreased (alert enough to describe events). Failure to respond: immediate assessment of A, B, C, and D.

STEP 1 Mechanism of Injury
STEP 2 Initial Vitals & GCS
STEP 3 Physiologic Criteria — Vital Signs & Level of Consciousness

Any positive: transport to highest level trauma center

STEP 4 Anatomic Criteria — Injury Pattern

Any positive: transport to trauma center

STEP 5 Mechanism Criteria — High-Energy Impact

Any positive: transport to trauma center or capable hospital

STEP 6 Special Patient & System Considerations

Special populations requiring additional consideration

Primary Survey — ABCDE

Systematic life-threat identification. Address each component sequentially. Intervene immediately for any identified threats before proceeding.

AAirway with C-Spine Protection
Assess airway patency while maintaining cervical spine immobilization.
  • C-spine immobilization in place
    Maintain inline stabilization during all airway maneuvers
  • Patient speaking / airway patent
    Vocalization confirms air movement through vocal cords
  • Inspect oropharynx — clear debris/blood
    Suction, remove foreign bodies, jaw thrust if needed
  • Signs of obstruction assessed
    Stridor, hoarseness, subcutaneous emphysema, facial/neck trauma
BBreathing & Ventilation
Assess chest wall movement, auscultate bilaterally, identify life-threatening thoracic injuries.
  • Chest wall integrity assessed
    Look for flail segments, open wounds, paradoxical movement
  • Bilateral breath sounds confirmed
    Auscultate apex and base bilaterally
  • Tracheal position midline
    Deviation suggests tension pneumothorax
  • Jugular venous distension checked
    JVD with hypotension: consider tension pneumo or tamponade
CCirculation & Hemorrhage Control
Assess perfusion, control external hemorrhage, evaluate for shock.
  • External hemorrhage controlled
    Direct pressure, tourniquet if extremity, wound packing
  • Pulse quality & rate assessed
    Weak/thready pulse suggests significant blood loss
  • Skin color/temperature/capillary refill
    Cool, pale, diaphoretic skin → hemorrhagic shock
  • Two large-bore IVs established
    Minimum 18G, antecubital preferred. Draw labs with access.
Shock Classification
DDisability — Neurologic Status
Rapid neurologic assessment: GCS, pupil response, lateralizing signs.
EExposure & Environment
Fully expose patient. Log roll and inspect posterior. Prevent hypothermia.
  • All clothing removed
    Complete exposure for thorough examination
  • Log roll — posterior inspection complete
    Inspect spine, flanks, buttocks, posterior thighs
  • Warming measures applied
    Warm blankets, warm IV fluids, warm environment
  • All injuries cataloged
    Document all identified injuries from head-to-toe

Secondary Survey — Head to Toe

Complete head-to-toe examination. Only begin after primary survey is complete and life threats addressed. AMPLE history and focused physical exam.

AMPLE AMPLE History
EXAM Regional Examination — Click to flag findings

Imaging Protocol

Recommended imaging based on mechanism, findings, and clinical concern. Adjust based on institutional protocols and patient stability.

IMMEDIATE Trauma Series (Standard)
  • Chest X-ray (AP portable)
    Pneumothorax, hemothorax, mediastinal widening, rib fractures
  • Pelvis X-ray (AP)
    Pelvic fractures — source of significant hemorrhage
  • FAST Exam (Focused Assessment with Sonography)
    RUQ, LUQ, pelvis, pericardium — evaluate free fluid
CT IMAGING Advanced Imaging — Select All That Apply
CT Head (non-contrast)
GCS <15, LOC, focal neuro deficit, skull fracture
CT C-Spine
Midline tenderness, neuro deficit, distracting injury, altered mental status
CT Chest (IV contrast)
Abnormal CXR, significant mechanism, thoracic aortic injury concern
CT Abdomen/Pelvis (IV contrast)
Positive FAST, abdominal tenderness, pelvic fracture, seatbelt sign
CT Angiography
Expanding hematoma, hard vascular signs, proximity injury
CT Face
Facial fractures, significant facial trauma, orbital injury
ADDITIONAL Additional Studies
Extremity X-rays
Deformity, point tenderness, swelling, crepitus
CTA Neck (BCVI screening)
C-spine fracture, Le Fort, Horner's, neuro deficit not explained by CT
RESULTS Imaging Findings — Document Results
Chest X-ray Findings
Pelvis X-ray Findings
FAST / eFAST Results
FAST Views
eFAST — Thoracic Views
CT Scan Results (document findings for each ordered study)

Disposition Decision

Based on assessment findings, determine patient disposition: discharge, admit, or transfer.

ASSESSMENT Key Disposition Factors

Trauma Service Admission Decision Tree

Trauma/ED Hospitalization Decision Tree (2-15-2024). Only the Trauma Service admits patients whose trauma injuries require admission. If the patient needs hospitalization for non-trauma reasons, the Hospitalist Service admits with trauma consult as needed.

STEP 1 Does this patient require hospitalization for their injuries?

Consulting Services

Click a service to initiate a consult. Green indicates the service is available on-call. Red indicates the service is not available — no consult actions are possible for unavailable services.

CONSULTS Initiate Consult

References & Supporting Documents

All clinical protocols and supporting documents. Upload PDFs to make them viewable by all users on this device.

DOCUMENTS Document Library
PDF, PNG, or JPG. Stored locally on this device.
  • No documents uploaded yet. Upload PDFs to view them here.
PRIMARY Primary Clinical Reference
ATLS — Advanced Trauma Life Support Student Course Manual, 10th Edition
American College of Surgeons Committee on Trauma. Copyright 2018.
ISBN: 78-0-9968262-3-5
Publisher: American College of Surgeons, Chicago, IL
Chapters referenced in this tool:
ChapterContent Used In
Ch 1 — Initial Assessment and ManagementDashboard, Primary Survey (ABCDE), Field Triage Decision Scheme (Fig 1-2), 10-Second Assessment, Mechanism-Injury Patterns (Table 1-1), Secondary Survey, Adjuncts
Ch 2 — Airway and Ventilatory ManagementPrimary Survey (A — Airway), RSI decision logic, Surgical airway indications
Ch 3 — ShockHemorrhagic Shock Classification (Table 3-1), Resuscitation guidance, MTP criteria, TXA administration
Ch 4 — Thoracic TraumaPrimary Survey (B — Breathing), Life-threatening thoracic injuries: tension pneumothorax, open pneumothorax, massive hemothorax, flail chest, cardiac tamponade, tracheobronchial injury
Ch 5 — Abdominal and Pelvic TraumaFAST/eFAST interpretation, FAST + hemodynamic status cross-referencing, Abdominal imaging decision logic
Ch 6 — Head TraumaGCS scoring, Pupil assessment, TBI severity classification, Neurosurgical consult criteria, Secondary brain injury prevention
Ch 7 — Spine and Spinal Cord TraumaC-spine clearance criteria (NEXUS/CCR reference), Spinal motion restriction, BCVI screening indications
Ch 8 — Musculoskeletal TraumaSecondary survey extremity assessment, Compartment syndrome identification
Ch 9 — Thermal InjuriesBurn mechanism injury patterns, Inhalation injury screening
Ch 10 — Pediatric TraumaField Triage Step 4 (pediatric considerations), Urine output targets
Ch 11 — Geriatric TraumaField Triage Step 4 (age >55/65 thresholds, SBP <110), Special population alerts
Ch 12 — Trauma in PregnancyField Triage Step 4 (pregnancy >20 weeks), hCG testing reminder
Ch 13 — Transfer to Definitive CareDisposition engine transfer criteria, Level I/II/III transfer triggers
STANDARDS Trauma Center Verification Standards
Resources for Optimal Care of the Injured Patient (2014)
American College of Surgeons Committee on Trauma. Used for: Trauma center level definitions (I/II/III), capability requirements, specialist availability standards, transfer criteria, response time benchmarks.
ACS Trauma Verification, Review, and Consultation (VRC) Program
American College of Surgeons. Used for: Level I/II/III capability comparison in hospital configuration, specialist requirements per level.
Guidelines for Field Triage of Injured Patients (CDC/MMWR, 2012)
Sasser SM, Hunt RC, et al. MMWR Recomm Rep. 2012;61(RR-1):1-20. Used for: Field Triage Decision Scheme (Steps 1-4), physiologic/anatomic/mechanism/special consideration criteria.
HOSPITAL Hospital-Specific Protocols — CaroMont Health
DocumentCategoryUsed In
Trauma/ED Hospitalization Decision Tree (2-15-2024)AdmissionService Decision — high vs low impact triage, service assignment
Fragility Fracture Admission Protocol (2024)AdmissionAge >50 low-energy fracture criteria, hospitalist vs trauma
Rib Fracture Admission Protocol (2024)AdmissionFVC-based disposition: MSICU vs IMCU vs floor vs discharge
2024 Rib Fx Admission AlgorithmAdmissionSupporting rib fracture admission algorithm
Trauma/Surgical Critical Care On-Call Decision TreeOperationsMSICU call routing — SCC vs trauma APP vs CCM
APP Tips & Tricks Provider OrientationOperationsProvider reference
Blunt Abdominal Trauma AlgorithmAbdominalFAST-guided blunt abdominal workup, serial exam, OR criteria
Abdominal GSW AlgorithmAbdominalGSW-specific abdominal management
Anterior Abdominal Stab Wound AlgorithmAbdominalAnterior stab wound evaluation pathway
Blunt Hepatic Trauma AlgorithmAbdominalLiver injury — CT, IR embolization, OR vs observe
Hemodynamically Unstable Pelvic Fx AlgorithmPelvisUnstable pelvic fracture (SBP <100) — FAST, packing, transfer
Revised Stable Pelvic Fx AlgorithmPelvisStable pelvic fracture (SBP >100) — binder, CT, IR vs OR
Penetrating Precordial Trauma — UnstableThoracicUnstable penetrating chest (SBP <100) — sternotomy vs thoracotomy
Penetrating Precordial Trauma — StableThoracicStable penetrating chest management
SSRF AlgorithmThoracicSurgical stabilization of rib fractures criteria
C-Spine Reliable Patient AlgorithmSpineC-spine clearance — reliable patient
C-Spine Unreliable Patient AlgorithmSpineC-spine clearance — unreliable patient (AMS, intoxicated)
ED Ground Level Fall Imaging GuidelinesImagingAge 60+ GLF imaging — anticoagulant vs non-anticoagulant
IR AlgorithmInterventionalIR consultation and procedure criteria
FFP Algorithm Revised 2024ResuscitationFresh frozen plasma administration protocol
MTAC Adult Trauma Transfer Guidelines v4.2TransferRegional transfer criteria, vital sign thresholds, facility contacts
MTAC Pediatric Transfer Guideline 2025Transfer / PedsPediatric transfer criteria, child abuse red flags, PTS scoring
CriSP-HS Trial — Early Cold Stored Platelet Transfusion Following Severe Injury (Sperry et al, Ann Surg 2024)Resuscitation / Blood ProductsPhase 2 RCT evidence for cold stored platelet (CSP) transfusion in hemorrhagic shock. 24-hr mortality 5.9% CSP vs 10.2% standard care (P=0.26). CSP safe out to 14 days storage. No increased thromboembolism. Supports early platelet resuscitation in trauma.
FDA Guidance — Alternative Procedures for Cold-Stored Platelets (June 2023)Regulatory / Blood ProductsFDA guidance for manufacture of apheresis CSP stored at 1-6°C for up to 14 days. Intended for treatment of active bleeding when conventional platelets are not available or not practical. Issued under 21 CFR 640.120(b). Covers manufacturing, bacterial contamination control, process validation, QC testing, and labeling.
24 hospital-specific protocols and references loaded.
UPLOADED Complete Document Inventory (25 files)
FilenameType
ATLS_Student_10th_edition_manual.pdfPDF (474 pp)
Trauma_Admit_Decision_Tree.pdfPDF
2024_Fragility_fracture_policy_plus_algorithmcomplete.pdfPDF
Rib_fx_algorithm_2024.pdfPDF
2024_rib_fx_admission_algorithm.pdfPDF
trauma_msicu_call_algorithm_revised.pdfPDF
APP_tipstricks_provider_orientation.pdfPDF
Blunt_Abdominal_trauma_algorithm.pdfPDF
Abdominal_GSW_algorithm.pdfPDF
Ant_Abd_Stab_Algorithm.pdfPDF
Blunt_Hepatic_Trauma_Algorithm.pdfPDF
Hemodynamically_unstable_pelvic_fx_algorithm.pdfPDF
Revised_stable_pelvic_fx_alg.pdfPDF
Unstable_Penetrating_precordial_trauma.pdfPDF
Stable_Penetrating_precordial_trauma.pdfPDF
SSRF_algorithm.pdfPDF
Cspine_reliable_patient_algorithm.pdfPDF
_Cspine_unreliable_patient_algorithm_1.pdfPDF
ED_GLF_imaging_guidelines.pdfPDF
IR_algorithm.docxDOCX
FFP_algorithm_revised_2024.pngPNG
MTAC_Adult_Patient_Trauma_Transfer_Guidelines_v4_2.pdfPDF
MTAC_Pediatric_Transfer_Guideline_Poster_2025.pdfPDF
early_cold_stored_platelet_transfusion_following_7.pdfPDF (10 pp)
Alternative-Procedures-for-Manufacture-of-Cold-Stored-Platelets.pdfPDF (15 pp)
25 total source documents.

Patient Summary

Comprehensive summary of all findings, imaging, consults, and plan from this assessment.

Hospital Configuration

Set up your facility's trauma level, available services, and specialist roster. This configuration customizes all decision trees and recommendations.

REQUIRED Trauma Center Designation
CAPABILITIES Available Services & Resources
ROSTER Specialist On-Call Configuration

All services default to available on-call. Click a service only if it is NOT available today. Confirm daily that no changes have occurred.

Daily Roster Confirmation Required
On-call roster has not been confirmed for today.