A standardized set of physiologic, anatomic, and mechanistic indicators used to identify patients who require care at a designated trauma center. Positive TTC is determined by the presence of qualifying criteria documented in eInjury.03 or eInjury.04 per NEMSIS v3.5. Classification follows the step-down hierarchy defined in your agency EMS Policy PD# xxxx.

The highest priority classification, captured in eInjury.03. Physiologic criteria include abnormal vital signs, altered mental status, respiratory distress, or shock. Anatomic criteria include specific injuries such as penetrating trauma to the head, neck or torso, suspected pelvic fracture, flail chest, spinal injury with neurologic deficit, or amputation proximal to the wrist or ankle. Any positive eInjury.03 value classifies the patient as positive TTC regardless of mechanism.

Applied when eInjury.03 is negative but eInjury.04 contains a qualifying high-energy mechanism of injury. Examples include falls greater than 10 feet, high-risk auto crash with significant compartment intrusion, ejection from a vehicle, pedestrian struck at speed greater than 20 mph, or motorcycle crash above 20 mph. Mechanistic criteria alone are sufficient to classify a patient as positive TTC per PD# xxxx.

Notification provided by the transporting unit to the receiving trauma center prior to patient arrival, documented in eDisposition.24. Pre-alerts allow the receiving facility to activate the trauma team and prepare resources before the patient arrives, which is associated with reduced time to definitive care. Pre-alert rate is calculated as the percentage of positive TTC patients for whom a trauma alert was documented in any eDisposition.24 field.

A case in which a patient meets positive TTC criteria but no trauma pre-alert was documented in any eDisposition.24 field during transport. Missed alerts represent a failure in the pre-hospital notification process and are a primary QI focus. Each missed alert is individually reviewed in the Flagged Incidents report and attributed to the transporting agency.

A case in which a trauma pre-alert was documented in eDisposition.24 but the patient did not meet positive TTC criteria under physiologic, anatomic, or mechanistic classification. While over-alerting can cause unnecessary resource activation at the receiving facility, clinical judgment may support transport decisions not fully captured in structured data fields. Over-alerts are flagged for review but are not held to the same standard as missed alerts.

Cases where eInjury.04 contains only provider judgment, anticoagulant or bleeding disorder history, pregnancy greater than 20 weeks, burn injuries, or suspicion of child abuse — without an accompanying qualifying mechanistic criterion. Per PD# xxxx, these patients may warrant trauma center transport at paramedic discretion but do not meet the threshold for positive TTC classification. Special considerations are tracked separately and are not included in pre-alert rate or destination compliance calculations.

The percentage of positive TTC patients transported to a designated trauma center, as identified by eDisposition.02. A compliant destination is any facility on the statewide LEMSA trauma center registry. Cases with null or unrecognized destination codes are counted as non-compliant and flagged separately for data quality review. The system target is 95% or greater per your agency EMS policy.