Table 1 Higher-level trauma center criteria of the National Protocol of Ambulance Services

ABC-unstable during evaluation on-scene

Revised trauma score < 11

Deteriorating Glasgow Coma Scale

Glasgow Coma Scale < 9

Flail chest

Amputation proximal to wrist or ankle

Two or more fractures of the femur and/or humerus

Penetrating injury of head, thorax, or abdomen

Unstable pelvic fracture

Body temperature < 32 °C

Neurologic deficit of one or more extremities

Anisocoria