Table 2.

Final set of criteria that reached consensus for inclusion by the panelists.

Patient factors

• GCS motor component <6

• Systolic blood pressure <90mmHg + clinical suspicion or mechanism with high risk of hemorrhage

• Penetrating injury to the head, neck, torso, or proximal extremities

• Suspected unstable pelvic fracture

• Crushed, degloved, mangled, or pulseless extremity

• Amputation proximal to wrist or ankle

• Active bleeding requiring a tourniquet, wound packing, or continuous pressure

• Multisystem trauma (e.g., potential or suspected severe injuries to 2 or more anatomic body regions: head/face, neck, chest, abdomen, upper extremities, lower extremities as evidenced by suspected injury beyond superficial lacerations or abrasions e.g., potential underlying fractures, intra-abdominal or thoracic injuries, signs of closed head injury)

• Injured patient with other medical need that otherwise would be transported by Ground EMS to center without both trauma & specialized services (e.g., OB/neonatal for pregnant patient, Burn services for concomitant burn/traumatic injury, PCI center for a patient with STEMI criteria, Stroke center for a patient with stroke symptoms)

• Suspected spinal injury with new motor or sensory loss

• Free abdominal or pericardial fluid on FAST ultrasound + clinical suspicion or mechanism with high risk of abdominal hemorrhage/cardiac injury

• Entrapped patient requiring active resuscitation, airway management, and/or amputation for extrication

• GCS < 13 with signs of head trauma if age ≥ 65

• CPR performed after trauma with ROSC (e.g., not in active arrest)

• Suspected thoracic injury + Respiratory distress (tachypnea, cyanosis, stridor/wheezing, retractions, diaphoresis, irregular breathing pattern or periodic apnea), or need for advanced respiratory support (need for suctioning/maneuvers to maintain open airway and/or need for ventilation)

• Suspected hemothorax or pneumothorax + Respiratory distress (tachypnea, cyanosis, stridor/wheezing, retractions, diaphoresis, irregular breathing pattern or periodic apnea), or need for advanced respiratory support (need for suctioning/maneuvers to maintain open airway and/or need for ventilation)

• Respiratory distress (tachypnea, cyanosis, stridor/wheezing, retractions, diaphoresis, irregular breathing pattern or periodic apnea), or need for advanced respiratory support (need for suctioning/maneuvers to maintain open airway and/or need for ventilation)

• Signs of head trauma + patient on anticoagulation/full dose antiplatelet therapy + GCS motor < 6

Time-sensitive Interventions + Clinician Factors

• Anticipated urgent need for specialized care not available by ground EMS in region that can be delivered by air medical crew

• Anticipated need for specialized care not available by ground EMS in region that can be delivered by air medical crew urgently (examples may include blood transfusion, drug assisted intubation, cricothyroidotomy or other advanced airway management, field amputation, vasopressor support, finger thoracostomy or chest tube placement, pelvic binder, resuscitative hysterotomy, etc.)

• Anticipated need for transfusion of blood or blood products urgently + not available from ground EMS

• Anticipated need for advanced airway management (endotracheal, drug assistant intubation, supraglottic airway, cricothyroidotomy) urgently + not available from ground EMS

• Anticipated need for vasopressors urgently + not available from ground EMS

• Potential need for surgical hemorrhage control urgently

System/Logistical/Operational Factors (Among injured patients with ACS NFTG or local triage criteria for transport to a trauma center)

• Difficult or inaccessible scene terrain/location that is safely accessible by helicopter

• Number of patients requiring trauma center care exceeds ground transport capabilities

• Anticipated total prehospital time savings of air medical transport over ground EMS ≥30 min

Combinations

• Patient with injury that is not definitely managed at closet trauma center and may benefit from transport to more distant specialized trauma center (e.g., severe TBI, spine injury, pelvic fractures based on knowledge of local system capabilities)

• Injured patient with STEMI criteria or acute stroke signs + air medical transport will reduce total prehospital time

• Anticipated total prehospital time savings of air medical transport over ground EMS ≥30 min + Patient has any ACS NFTG RED criteria

• Patient requires any of following interventions: advanced airway management, chest decompression, blood transfusion, vasopressor support, tourniquet placement, pelvic binder placement + air medical crew would arrive prior to ground EMS arriving at a trauma center in clinically significant time frame

• Anticipated need for specialized care not available by ground EMS in region that can be delivered by air medical crew (examples may include blood transfusion, drug assisted intubation, cricothyroidotomy or other advanced airway management, field amputation, vasopressor support, finger thoracostomy or chest tube placement, pelvic binder, resuscitative hysterotomy, etc.) + air medical crew would arrive prior to ground EMS arriving at a trauma center by 30 min

• Ground EMS would only otherwise transport to a non-trauma center in patient that meets any ACS NFTG RED or YELLOW criteria or local triage criteria for transport to a trauma center

EMS, emergency medical services; ACS NFTG, American College of Surgeons National Field Triage Guidelines; GCS, Glasgow Coma Scale; CPR, cardiopulmonary resuscitation; ROSC, return of spontaneous circulation; OB, obstetrics; PCI, percutaneous coronary intervention; STEMI, ST-elevation myocardial infarction.