Trauma Triage Protocols for the Emergency Veterinarian

Principles of Trauma Triage

Trauma is among the most common presentations in veterinary emergency medicine and a leading cause of acute mortality in companion animals. Effective triage—the rapid sorting of patients by injury severity and physiologic urgency—is the critical first step in reducing preventable trauma deaths.

The goal of trauma triage is not diagnosis but prioritization. Identifying immediately life-threatening conditions that require intervention in minutes takes precedence over thorough characterization of every injury. A structured, reproducible approach minimizes omissions under pressure and ensures that the most critically injured patients receive resources first.

The Primary Survey

The primary survey follows an ABCDE framework adapted from human trauma medicine. It should be completed within 60–90 seconds of patient contact.

Airway

Assess patency immediately. In unconscious patients, open the airway by extending the neck and examining the oropharynx for obstruction, blood, or foreign material. Intubate immediately if airway patency cannot be maintained, if there is significant maxillofacial trauma, or if respiratory distress is present.

Breathing

Evaluate respiratory rate, effort, and symmetry. Life-threatening chest injuries that must be identified at the primary survey include:

• Tension pneumothorax: absent breath sounds, tracheal deviation, hemodynamic collapse — decompress immediately
• Open pneumothorax: visible sucking chest wound — cover and seal
• Massive hemothorax: dull ventral thorax, shock — thoracocentesis
• Flail chest: paradoxical movement — positive pressure ventilation if respiratory failure

Circulation

Assess pulse quality, capillary refill time, and mucous membrane color. Identify and control active hemorrhage. Apply direct pressure to compressible wounds. In patients with ongoing hemorrhage and hemodynamic instability, initiate permissive hypotension strategy (see Fluid Resuscitation).

Rapidly assess for pericardial effusion/tamponade, particularly in cats following thoracic trauma.

Disability (Neurologic Status)

Assign a rapid neurologic grade using a modified Glasgow Coma Scale for dogs or the Feline Glasgow Coma Scale for cats. Document pupil symmetry and size. Identify spinal cord involvement based on limb motor function and pelvic tone.

Exposure and Environment

Remove collars and examine for wounds not immediately apparent. Obtain a rectal temperature. Hypothermia is common in trauma patients and worsens coagulopathy significantly.

Focused Assessment with Sonography for Trauma

FAST (Focused Assessment with Sonography for Trauma) has become a standard adjunct to the primary survey in veterinary emergency settings. The abdominal FAST (AFAST) protocol evaluates four acoustic windows for free fluid:

1. Diaphragmatico-hepatic view
2. Spleno-renal view
3. Cysto-colic view
4. Hepato-renal view

The thoracic FAST (TFAST) protocol assesses for pleural and pericardial effusion and pneumothorax via the glide sign.

FAST does not replace radiography but allows rapid detection of free fluid in the unstable patient who cannot safely undergo positioning for survey radiographs.

Trauma Scoring

Quantitative trauma scores allow serial assessment of physiologic trajectory and prognostic stratification. The Animal Trauma Triage (ATT) score evaluates six physiologic parameters (perfusion, cardiac, respiratory, eye/muscle/skeletal, and level of consciousness), with higher scores correlating with increased mortality. An ATT score ≥ 5 has been associated with significantly increased mortality in retrospective studies.

Serial scoring at 0, 4, and 12 hours provides more prognostic information than a single score and helps identify patients who are failing to respond to initial stabilization.

Initial Stabilization Priorities

Stabilization occurs concurrently with triage in the critically injured patient. Simultaneous venous access (two large-bore peripheral catheters, or jugular catheterization in severe hypovolemia), fluid resuscitation, oxygen supplementation, and analgesia should proceed without waiting for complete diagnostic workup.

Analgesia must not be withheld in trauma patients. Uncontrolled pain worsens catecholamine-driven vasoconstriction, increases oxygen consumption, and complicates repeated examination. Opioids (methadone or hydromorphone) are first-line analgesics and do not mask neurologic findings in the meaningful clinical sense.

Transition to Secondary Survey

Once the primary survey is complete and immediate life threats are controlled, a head-to-tail secondary survey is performed to identify all injuries. At this stage, survey thoracic and abdominal radiography, orthogonal views of suspected fractures, and laboratory assessment (PCV, TP, blood gas, electrolytes, creatinine) are obtained.

Injury inventory from the secondary survey drives surgical and intensive care planning. Communication with the owner should occur at this transition point, providing a realistic assessment of injury severity, anticipated interventions, and short-term prognosis.