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A key transport decision is selecting the appropriate destination hospital, specifically whether a patient should be transported to a hospital designated as a trauma center or not. One important aspect of this initial care is accurately identifying which trauma patients are likely to have a serious injury so that this information can be used to inform triage and transport decisions. Appropriate initial care is critical for successfully addressing injury and restoring quality of life. 2 Out-of-hospital care includes the early interventions and life support needed to prevent immediate deterioration and secure vital functions. 1 Pathways of care for trauma patients, which include people with intentional as well as unintentional injuries, are based on systems of care that address the various stages along the trauma chain of survival (Figure 1). In 2011, there were approximately 40 million emergency department (ED) visits for injuries of these, 2.5 million were due to trauma complications and unspecified injuries. In 2014, unintentional injury was the fourth leading cause of death in the United States, the leading cause for people 1 to 44 years of age, and in the top five for all age groups except people 65 and older (seventh for this group). The ultimate goal is to promote the efficient and effective use of trauma care resources in order to achieve good outcomes for patients. This review is designed to help inform decisions about what measures should be recommended in field triage guidelines and promoted for use in EMS practice. EMS personnel then use this information to inform triage and transport decisions. In field triage, emergency medical services (EMS) personnel assess and monitor circulation and respiration in a broad range of trauma patients to identify those who have severe injuries and who are likely to need high level trauma care. The review is focused on measures that can be used in the field to triage trauma patients. The purpose of this systematic review is to identify and summarize the research evidence evaluating measures of circulatory and respiratory compromise. Objectives, Background and Rationale Objective To view the amendments, go to " Summary of Protocol Amendments." I. On amendments were made to this protocol.