| Physiologic criteria: |
| Systolic blood pressure < 90 mm Hg |
| Respiratory rate < 10, >29 breaths/min, or need for airway management |
| Glasgow Coma Scale score ≤ 12 |
| Anatomic criteria: |
| Flail chest |
| Two or more long bone (humerus/femur) fractures |
| Penetrating injury to the head, neck, torso, or groin |
| Amputation proximal to the wrist or ankle |
| Suspected spinal cord injury with paralysis |
| Mechanism of injury: |
| Extrication time > 20 minutes |
| Death of occupant in same vehicle |
| Ejection from vehicle |
| Discretionary criteria: |
| High-energy mechanism (fall > 20 feet, pedestrian vs. auto, motorcycle/ all-terrain vehicle /bicycle crash, rollover, passenger space intrusion) |
| Comorbid conditions (age < 5 or > 55 years, anticoagulation, medical illness, pregnancy, intoxication, hostile environment) |
| Paramedic discretion |
