Consider early referral of critically injured trauma patients to a higher level of care if:

• Airway problem that required intervention– needs unit with advanced airway skills)

• The person is displaying signs of shock

    - Tension pneumothorax: perform a needle decompression prior to transfer (needs urgent chest tube placement)
    - Pericardial tamponade: ensure IV fluids started and continued on transfer

Consider early referral of critically injured trauma patients to a higher level of care if:

• Altered mental status or drowsy, lethargic
• Pregnant women: place on her side for transport (needs specialist obstetric care)
• Child with ABCDE problem or any head, chest, or abdominal injury
• Any serious burn injury. Assess burn depth and total burn surface area, commence fluid resuscitation (preferably transfer to a specialist burns unit)