Ohio Trauma Triage: Criteria, Destination Rules, and EMS Immunity

Ohio’s trauma triage laws tell emergency medical crews how to decide whether an injured person is a trauma victim and where that person must be taken. The rules sit in Chapter 4765 of the Ohio Revised Code and the matching chapter of the Ohio Administrative Code, and they share a single default: if a patient meets the state’s triage criteria, EMS transports directly to a qualified trauma center unless one of five defined exceptions applies.¹

Where the Rules Come From

Two bodies of law control. The Ohio Revised Code (ORC) Chapter 4765 sets the authority and the broad requirements. The Ohio Administrative Code (OAC) Chapter 4765 fills in the clinical detail, including the specific triage criteria EMS applies in the field.

The State Board of Emergency Medical, Fire, and Transportation Services, housed in the Ohio Department of Public Safety’s Division of EMS, writes and enforces the rules. ORC 4765.40 directs the Board to adopt written triage protocols for both adult and pediatric trauma victims and requires those protocols to send qualifying patients straight to a trauma center, subject to the exceptions discussed below.¹ Regional EMS advisory boards can add their own protocols, but regional rules must meet the statewide floor and cannot steer patients to one trauma center over another for reasons unrelated to medical need.

How EMS Decides Someone Is a Trauma Victim

OAC Rule 4765-14-02 is the operational heart of Ohio’s triage system. It splits patients into three age groups: adults (16 to 69), pediatric patients (under 16), and geriatric patients (70 and older). Within each group, EMS screens for three kinds of indicators: physiological signs, anatomical injuries, and mechanism of injury. Meeting even one indicator in any category qualifies the patient as a trauma victim who should go to a trauma center.²

Physiological Signs

For adults, the physiological triggers are a Glasgow Coma Scale score of 13 or below, loss of consciousness lasting more than five minutes, a deteriorating level of consciousness on scene or during transport, a respiratory rate below 10 or above 29, a need for breathing support, a pulse above 120 combined with signs of hemorrhagic shock, or a systolic blood pressure below 90.²

Geriatric patients get a lower bar on two measures. A GCS of 14 or below triggers triage when a traumatic brain injury is known or suspected, and the systolic blood pressure threshold rises to below 100 instead of 90.³

Pediatric criteria focus on poor perfusion, respiratory distress or failure, and a respiratory rate below 20 for infants under one year. The GCS threshold is the same 13 or below used for adults.²

Anatomical Injuries

The anatomical list asks what is injured and how badly. For adults, it covers penetrating injuries to the head, neck, or torso; significant penetrating trauma to an arm or leg above the knee or elbow with nerve or vessel involvement; visible crush injuries; abdominal tenderness or a seatbelt mark across the abdomen; pelvic fractures; flail chest; amputations above the wrist or ankle; fractures of two or more long bones; signs of spinal cord injury; and open skull fractures.²

Burns fit in the same category. Second- or third-degree burns covering more than 10 percent of total body surface area, or significant burns to the face, feet, hands, genitalia, or airway, qualify a patient as a trauma victim.² The American Burn Association separately recommends burn-center consultation for all chemical injuries, high-voltage electrical injuries, suspected inhalation injuries, and any pediatric burns.⁴

Mechanism of Injury

Ohio’s mechanism trigger is narrower than many people expect. Under OAC 4765-14-02, the specific mechanism indicators for adults are vehicle telemetry data consistent with a high risk for injury and an on-scene fatality in the same vehicle.² High-speed collisions, falls from height, and pedestrian strikes still matter clinically, but the formal rule ties the mechanism criterion to telemetry evidence and same-vehicle deaths rather than a long list of crash types.

Where a Trauma Victim Has to Be Taken

If a patient meets any of the criteria above, the default under ORC 4765.40 is transport directly to a trauma center qualified to handle the injuries. Five exceptions let EMS go somewhere else:¹

The patient needs initial assessment and stabilization at a closer hospital before transfer.
Weather, road conditions, or excessive transport time make direct transport unsafe.
Sending the ambulance to a distant trauma center would leave the local area without EMS coverage.
No appropriate trauma center can accept the patient without undue delay.
The patient, or an authorized family member or legal representative, asks before transport begins to go to a specific hospital that is not a trauma center.

Regional protocols can incorporate some or all of these exceptions and take priority inside their region, as long as they meet statewide minimums.¹

Patient and Family Say in the Destination

The patient-request exception surprises most people. A conscious adult trauma patient can direct EMS to a non-trauma hospital, provided the request is made before transport begins. If the patient is under 18 or unable to communicate, an adult family member or legal representative can make that request instead. The crew will typically explain the risks and document the request carefully, but the statutory right to choose is there.¹

Air Versus Ground Transport

Ohio law does not include a specific regulation dictating when a helicopter must be used instead of a ground ambulance. The decision is a clinical judgment driven mostly by transport time. General EMS guidance in Ohio points toward ground transport when a trauma center is less than 20 minutes away, helicopter consideration between 20 and 30 minutes, and helicopter transport when ground time would exceed 30 minutes. Crews are told not to delay leaving the scene just to wait for a helicopter if ground transport can get moving sooner.

What Counts as a Trauma Center

Ohio defines a “trauma center” as any hospital verified by the American College of Surgeons (ACS) as an adult or pediatric trauma center, any hospital operating under provisional status, or any out-of-state hospital licensed under its own state’s laws to provide specialized trauma care.⁵ Ohio facilities range from Level I centers with round-the-clock surgical teams and research programs down to Level III centers that can stabilize and transfer complex cases. Hospitals seeking recognition must obtain ACS verification covering staffing, surgical capability, equipment, and quality improvement, and that verification must be renewed periodically.

Immunity When EMS Gets It Wrong

Triage decisions happen fast, and ORC 4765.49 shields the people making them. An EMR, EMT, Advanced EMT, or paramedic is not liable for injury, death, or property loss resulting from emergency medical services unless those services were provided in a manner that constitutes willful or wanton misconduct.⁶ That standard is well above ordinary negligence. It requires conscious disregard of a known risk or reckless indifference to patient safety. An honest field mistake, such as calling for ground transport when a helicopter might have been faster, falls short.

The same immunity extends to physicians, physician assistants, and registered nurses who advise crews remotely by radio or telemetry, to medical directors of EMS organizations, and to out-of-state EMS providers who cross into Ohio while performing EMS functions under their home state’s authority.⁶ The protections do not apply where a provider violates mandatory reporting duties or falls below minimum care standards in a way that itself rises to willful or wanton conduct.

A Note on Ambulance Bills

Ohio’s triage laws govern clinical decisions and transport destination, not what you will owe afterward. The federal No Surprises Act, which took effect in 2022, protects patients from surprise billing for most emergency services but deliberately excludes ground ambulance transport. Ohio is among roughly 22 states that have added state-level protection, and Ohio’s surprise billing law does extend to ground ambulances. Air ambulance transport is covered by the federal law’s balance-billing protections, though out-of-pocket costs can still be substantial under high-deductible plans. Checking your plan’s emergency transport coverage before an emergency is the realistic way to avoid being blindsided.

1
Ohio Legislative Service Commission. Ohio Revised Code Section 4765.40 – Written Protocols for Triage of Adult and Pediatric Trauma Victims
2
Ohio Legislative Service Commission. Ohio Administrative Code Rule 4765-14-02 – Determination of a Trauma Victim
3
Ohio Legislative Service Commission. Ohio Administrative Code Chapter 4765-14 – Trauma Triage
4
American Burn Association. Guidelines for Burn Patient Referral
5
Ohio Legislative Service Commission. Ohio Revised Code Chapter 4765 – Emergency Medical Services
6
Ohio Legislative Service Commission. Ohio Revised Code Section 4765.49 – Emergency Medical Personnel and Agencies Immunity