Learn how MetroHealth works with the Northern Ohio Trauma System (NOTS) to coordinate and optimize trauma triage and care.
FieldBrief Issue 1
Published March 24, 2026
Northern Ohio Trauma System (NOTS) Field Triage
Every trauma call starts with a critical decision: where the patient should go.
In Northern Ohio, those decisions are shaped by the Northern Ohio Trauma System (NOTS), a regional collaboration launched in 2010 by MetroHealth and Cleveland Clinic to improve trauma outcomes through data, research and coordinated care.
For EMS and first responders, NOTS data and research directly influence trauma protocols and field triage decisions.
NOTS:
- Implements evidence-based protocols (for example, “scoop and run”)
- Develops quality improvement action plans
- Establishes regional guidelines
- Expands trauma education
- Strengthens collaboration across the trauma system
Much of this work begins in the field—with EMS.
“We’re not just here as a resource, we’re here for education,” says Director of NOTS Danielle Rossler, RN, BSN, MBA.
NOTS’ mission: The right patient. The right place. The right time.
NOTS Begins with EMS
As first responders to trauma, your initial assessment and triage greatly impact survivability.
“Without our first responders, without a robust, uniform, evidence-based field triage system in our region, NOTS wouldn’t exist,” says Jeremiah Escajeda, MD, Medical Director of Cleveland Department of Public Safety and a MetroHealth emergency medicine physician.
Over the past 16 years, NOTS EMS committees have examined trauma data, trends and research, resulting in changes to protocols or procedures to improve patient outcomes.
NOTS partners with local, state and national organizations to collect trauma data, including:
NOTS Influence on Trauma Triage Criteria
First responders rely on Ohio’s triage rules to determine patients’ prehospital injury patterns and the most appropriate destination within a given time to maximize care. Key components include:
- Physiological indicators
- Anatomical indicators
- Mechanism of injury
- Special considerations (such as pediatric patients, pregnant patients or geriatric-specific indicators)
NOTS analyzes regional trauma data to refine field triage guidelines.
All NOTS hospitals record both ICD-10 injury codes and NOTS-specific mechanism categories, allowing researchers to track injury patterns across the region and identify opportunities to improve protocols.
For example:
- Geriatric age: Ohio classifies geriatrics as 70+. NOTS classifies geriatrics as 65+.
- Falls: Many trauma triage algorithms discuss falls from 20+ feet. But evidence shows falls from 10+ feet can result in significant injuries. NOTS data has refined regional algorithms.
Where You Go Matters
Today, the NOTS network includes 16 trauma centers and one burn center across Northern Ohio.
NOTS has found that patients are sometimes transported to the closest hospital—often a Level III—when they need a higher-level hospital. This can result in unnecessary transfers.
“If you know someone shouldn’t go to a lower level of care, go that extra mile,” Rossler says.
Current NOTS Hospitals
Level I | Level II | Burn Center |
| Cleveland Clinic Akron General | Cleveland Clinic Fairview Hospital | MetroHealth Medical Center |
| MetroHealth Medical Center (Adult) | Cleveland Clinic Hillcrest Hospital | |
| University Hospitals Cleveland Medical Center | Cleveland Clinic Mercy Hospital—Canton | |
| University Hospital Rainbow Babies & Children | MetroHealth Medical Center (Pediatric) |
Trauma Care Levels
- Level I Trauma Care
– Highest level of trauma care
– 24/7 surgical coverage
– Immediate access to subspecialists - Level II Trauma Care
– Provides comprehensive trauma care
– May transfer complex cases to Level I centers - Level III Trauma Care
– Stabilizes most trauma patients
– Transfers severe cases to higher-level centers
Field Triage Saves Time—and Lives
Field triage decisions are one of the most important factors in trauma survival.
NOTS continues to analyze regional data to refine protocols and support EMS providers in getting patients to the right level of care as quickly as possible.
Learn more at the NOTS 16th Annual Trauma Symposium, November 9, 2026, at the Huntington Convention Center of Cleveland.
To claim EMS Continuing Education for this edition of FieldBrief, please visit metrohealth.org/fieldbrief and complete a brief survey. The survey link is located below the list of articles.
MetroHealth Medical Center is a State of Ohio Approved Continuing Education Site #1202
Key Takeaways
- NOTS: The right patient. The right place. The right time.
- NOTS data and research results in changes to protocols and procedures.
- Appropriate field trauma triage can reduce unnecessary transfers.
- Attend the NOTS 16th Annual Trauma Symposium on November 9, 2026.
