March 24, 2026
Mayo Clinic Trauma Center has revised their trauma team activation (TTA) criteria to ensure patients receive the right level of care while clinical resources are used efficiently. The previous TTA criteria review occurred in 2020.
"It's good to have a regular review so we ensure we meet patients' needs with an activation and be sure we use all resources appropriately," says Rachel A. Duchsherer, M.S.N., R.N., adult trauma program manager and Trauma Center nurse manager at Mayo Clinic in Rochester, Minnesota. "Completing a regular TTA review is a standard for trauma centers."
Key changes to Mayo Clinic's TTA criteria
During the latest review, leaders focused on clarity, simplicity and alignment with American College of Surgeons (ACS) standards.
Updates include:
- Simplified red criteria: Airway and breathing criteria were combined for ease of use.
- Removal of electrocution: High‑voltage electrocution rarely stands alone as a trigger and typically fits within other criteria.
- Updated Glasgow Coma Score (GCS) threshold: The activation threshold now aligns with ACS guidance at a GCS less than 9.
Benefits for trauma staff and patients
Duchsherer anticipates that the revised criteria will streamline trauma patient leveling and reduce unnecessary disruptions for clinical teams.
The more concise criteria allow trauma resource nurses (TRNs) to level patients more quickly — critical in a role that requires rapid decision‑making and multitasking. Faster leveling also expedites patient access to appropriate care, a cornerstone of trauma management.
Additionally, clearer criteria mean medical and surgical teams are activated only when truly needed, reducing workflow interruptions and preserving resources for the most critical patients.
How trauma centers develop TTA criteria
Trauma centers base their criteria on ACS requirements and add elements tailored to their patient population and operational needs.
"This is all about utilizing resources correctly. We don't want to pull resources to the emergency department if the patient there is not the most critical. We want to avoid taking them from a patient who is more critical."
ACS criteria include but are not limited to:
- GCS less than 9 with mechanism attributed to trauma. Gunshot wounds to the neck, chest or abdomen.
- Patients who have respiratory compromise or need an emergent airway.
A notable ACS consideration is that patients age 55 and older must be treated as advanced trauma patients due to increased morbidity and mortality.
Mayo Clinic Trauma Center adds criteria specific to their environment, including but not limited to falls of greater than 20 feet (6 meters) or burns of greater than 10% of the body surface area.
Because each trauma center sets its own criteria, a patient who initiates a TTA at one facility may not initiate one at another. By the time a patient arrives at a second center, stabilization or evolving clinical needs also may change the activation level.
Focus and frequency of TTA review
Duchsherer notes that the TTA review aimed to ensure that necessary teams are activated without unnecessarily pulling clinicians from the OR, ICU or many other locations.
She describes past situations where full activation brought multiple specialists to the bedside, only for the patient to have minimal injuries requiring a single specialty.
"This is all about utilizing resources correctly," she says. "We don't want to pull resources to the emergency department if the patient there is not the most critical. We want to avoid taking them from a patient who is more critical."
To refine the criteria, the team relied on:
- Critical thinking from trauma staff.
- Observations of patient trends and needs.
- ACS guidance.
While ACS does not mandate a specific review cadence, Duchsherer emphasizes the importance of regular evaluation.
"We're always in a state of review of our TTAs," she says.
How TTA criteria are applied at Mayo Clinic
When EMS reports an incoming patient, the trauma resource nurse reviews the TTA criteria and asks clarifying questions. If uncertain, the trauma resource nurse consults with an ED physician; Trauma, Critical Care and General Surgery surgeons; or another trauma resource nurse.
Mayo Clinic uses a color-coded activation system:
- Red: High-level activation; all surgeons must arrive at the bedside within 15 minutes.
- Yellow: Low-level activation; surgeons have six hours to report, though most arrive within 30 minutes.
- Green: Nonactivation.
Other facilities may use a simple activation system or no activation system.
A TTA ensures lifesaving services are available immediately upon a patient's arrival. The goal is to have the whole team ready for the patient prior to the patient's arrival. When additional specialty services not included in the initial TTA are needed for a specific patient, the team will notify that specialty service by page or phone call. In some cases, specialty consultation occurs before the patient arrives, such as when a head bleed requires neurosurgical involvement.