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 (xABCDE), 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

Document mechanism of injury, initial vitals, and prehospital triage criteria. This section captures how and why the patient arrived and identifies injury severity to guide your workup.

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 Patient Demographics & Initial Vitals
yr
lbs
bpm
mmHg
/min
%
°F
/15
Field Triage Criteria (ATLS 11th Ed / 2021 National Guidelines) — RED criteria indicate highest-level trauma center transport. YELLOW criteria indicate preferential transport to a trauma center. For patients already at your facility, these criteria help identify injury severity and flag patients who may need transfer.
RED Physiologic Criteria — Vital Signs & Level of Consciousness

Any positive indicates severe physiologic derangement. Evaluate for transfer to Level I trauma center if injuries exceed facility capability.

RED Anatomic Criteria — Injury Pattern

Any positive indicates significant anatomic injury. Ensure required surgical specialties are available. If not, initiate transfer.

YELLOW Mechanism Criteria — High-Energy Impact

Any positive indicates high-energy mechanism. Maintain high index of suspicion for occult injuries. Full trauma workup indicated.

YELLOW Special Patient & System Considerations

Special populations requiring additional consideration

Primary Survey — xABCDE

ATLS 11th Edition systematic life-threat identification. The "x" addresses eXsanguinating external hemorrhage first. Then assess Airway, Breathing, Circulation, Disability, and Exposure sequentially.

xeXsanguinating External Hemorrhage Control
Rapid visual check for massive external bleeding. Control immediately — takes seconds and is performed while other team members prepare airway assessment. (ATLS 11th Ed, Ch 2-3)
  • Visual sweep for massive external bleeding
    Inspect patient, clothing, stretcher for pooling blood or arterial spurting
  • Direct pressure / wound packing applied
    Gauze dressing over bleeding site, pack deep wounds
  • Tourniquet applied if extremity hemorrhage uncontrolled
    2-3 inches proximal to wound, on skin not clothing, not over joint. Tighten until distal pulse absent. Record time.
  • Scalp hemorrhage controlled
    Direct pressure, sutures, or clips. Monitor even after controlled.
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 Index (auto-calculated from vitals) ATLS 11th Ed, Ch 6
Enter HR and Systolic BP on the Triage tab to calculate.
ABC Score — MTP Activation Trigger ATLS 11th Ed, Ch 6/22
Auto-calculated from vitals, FAST, and MOI. Score ≥2 = consider MTP.
Hemorrhage Classification (clinical estimate)
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

Labs & EKG

Enter pertinent lab results. Abnormal values auto-trigger alerts and repeat reminders.

BASIC PANELS CBC / BMP / Lactate / Blood Gas
g/dL
%
K/µL
K/µL
mEq/L
mEq/L
mg/dL
mg/dL
mg/dL
mmol/L
pH
mEq/L
COAG Coagulation ▸
CARDIAC Cardiac / EKG ▸
URINE Urinalysis / Pregnancy / Tox ▸
BLOOD BANK Type & Screen / Transfusion ▸
OTHER Lipase / Other ▸

Imaging Protocol

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

IMMEDIATE Trauma Series
Chest X-ray (AP portable)
Pneumothorax, hemothorax, mediastinal widening, rib fractures
▼
Pelvis X-ray (AP)
Pelvic fractures — source of significant hemorrhage
▼
FAST / eFAST Exam
RUQ, LUQ, pelvis, pericardium — evaluate free fluid
▼
CT & ADVANCED CT Imaging & Additional Studies
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
▼
CTA Neck (BCVI screening)
C-spine fracture, Le Fort, Horner's, neuro deficit not explained by CT
▼
Extremity X-rays
Deformity, point tenderness, swelling, crepitus
▼
Other Imaging
T/L spine, retrograde urethrogram, etc.
▼

Disposition Decision

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

ASSESSMENT Key Disposition Factors

For patients with ≥2 rib fractures or sternal fracture. Per CaroMont Rib Fracture Admission Protocol.

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, 11th Edition
American College of Surgeons Committee on Trauma. Copyright 2024.
Publisher: American College of Surgeons, Chicago, IL
Chapters referenced in this tool:
ChapterContent Used In
Ch 1 — Initial Assessment: Primary SurveyDashboard, Primary Survey (xABCDE), Field Triage (2021 RED/YELLOW criteria), 10-Second Assessment, Mechanism-Injury Patterns
Ch 2 — Resuscitation Team Function and CommunicationTeam dynamics, MIST handover tool
Ch 3 — Control of eXsanguinating External HemorrhagePrimary Survey (x step), tourniquet application, direct pressure, wound packing
Ch 4 — Airway Assessment and ManagementPrimary Survey (A — Airway), modified RSI, video laryngoscopy, surgical airway
Ch 5 — Breathing and Ventilation AssessmentPrimary Survey (B — Breathing), tension/open pneumothorax, massive hemothorax, flail chest, cardiac tamponade, needle decompression (dual site)
Ch 6 — Circulation Assessment and Volume ResuscitationShock Index, ABC Score for MTP, hemorrhage classification, whole blood resuscitation, permissive hypotension, damage control resuscitation
Ch 7 — Disability: Neurological AssessmentGCS scoring, pupil assessment, TBI classification, spinal cord injury, secondary brain injury prevention
Ch 8 — Exposure and Environmental ThreatsHypothermia prevention, lethal triad, full exposure
Ch 9 — Thermal InjuriesBurn mechanism injury patterns, inhalation injury
Ch 10 — Musculoskeletal TraumaExtremity assessment, pelvic fractures (Young-Burgess), open fracture antibiotics, compartment syndrome
Ch 11 — Trauma in the Pediatric PatientPediatric vital signs, weight-based resuscitation, blood loss classification (Mild/Moderate/Severe), modified GCS
Ch 12 — Trauma in the Older AdultGeriatric thresholds (SBP <110), anticoagulant considerations, lower injury thresholds
Ch 13 — Trauma in the Pregnant PatientLeft lateral tilt, Kleihauer-Betke, RhoGAM, fetal monitoring
Ch 14 — Initial Assessment: Secondary SurveyHead-to-toe evaluation, AMPLE history, tourniquet conversion
Ch 15 — Transfer to Definitive CareTransfer criteria, trauma center capabilities, interhospital transfer protocols
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.
National Guideline for the Field Triage of Injured Patients (2021)
Newgard CD, Fischer PE, Gestring M, et al. J Trauma Acute Care Surg. 2022;93(2):e49-e60. Used for: Field Triage RED/YELLOW criteria, 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 Document Library (47 files)
▶ ATLS 11th Edition 23 files
▶ Hospital Trauma Protocols 16 files
▶ Admission & Transfer Guidelines 5 files
▶ Research & Regulatory 3 files
47 documents across 4 categories.

Patient Summary

Comprehensive summary of all findings, imaging, labs, consults, and plan. Use "Copy Summary" to export as plain text for your EMR.

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
ROSTER Specialist On-Call Configuration

Click each service to cycle: Available Day + Night → Day Only → Not Available. Confirm daily.

Confirm on-call roster for today
CAPABILITIES Available Services & Resources