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FA-64636 / Clinical triage scoring / Open access

Stepwise field trauma destination tiering: older adult systolic threshold · case 01

A 65-year-old with systolic 101 is not recognised as hypotensive for their age.

Verified by executionVariant 1 · 11 checks per implementationDownload source bundle ↓JSON ↗

ROOT CAUSE

The raised systolic threshold for older adults is not applied.

VERIFIED REPAIR

Use a systolic threshold of 110 for age >= 65.

Unsuccessful approach: Using > 65 skips patients who are exactly 65.

Case contract

Input {gcs, sbp, rr, age, penetrating_torso, flail_chest, two_long_bone_fx, fall_m, ejection, anticoag, pregnant_weeks}. Toy steps in order: (1) gcs <= 13, sbp below 90 (below 110 when age >= 65), rr < 10 or rr > 29 -> TIER1 step 1; (2) penetrating torso, flail chest or two long-bone fractures -> TIER1 step 2; (3) fall above 6 m (above 3 m when age < 15) or ejection -> TIER2 step 3; (4) anticoagulation, pregnancy beyond 20 weeks or age >= 65 -> TIER3 step 4; else LOCAL step 0. Return {tier, step}.

Why this case matters

Field triage is an ordered cascade of age-adjusted physiological, anatomical and mechanism criteria; each comparison is a separate fault site.

1 / The failure

Exit 1
"""Failure Map reference implementation. Python standard library only."""
import json

N = 1
observations = []
def solve(x):
    a = x['age']
    sbp_lim = 90
    if x['gcs'] <= 13 or x['sbp'] < sbp_lim or x['rr'] < 10 or x['rr'] > 29:
        return {'tier': 'TIER1', 'step': 1}
    if x['penetrating_torso'] or x['flail_chest'] or x['two_long_bone_fx']:
        return {'tier': 'TIER1', 'step': 2}
    fall_lim = 3 if a < 15 else 6
    if x['fall_m'] > fall_lim or x['ejection']:
        return {'tier': 'TIER2', 'step': 3}
    if x['anticoag'] or x['pregnant_weeks'] > 20 or a >= 65:
        return {'tier': 'TIER3', 'step': 4}
    return {'tier': 'LOCAL', 'step': 0}
def check(label, actual, expected):
    observations.append({"check": label, "actual": actual, "expected": expected, "passed": actual == expected})
fixtures = [[('uninjured control',
   {'gcs': 15,
    'sbp': 130,
    'rr': 16,
    'age': 31,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 0,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 0},
   {'tier': 'LOCAL', 'step': 0}),
  ('65-year-old with systolic 100',
   {'gcs': 15,
    'sbp': 101,
    'rr': 16,
    'age': 65,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 0,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 0},
   {'tier': 'TIER1', 'step': 1}),
  ('bradypnoea',
   {'gcs': 15,
    'sbp': 130,
    'rr': 9,
    'age': 40,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 0,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 0},
   {'tier': 'TIER1', 'step': 1}),
  ('respiratory rate exactly 10',
   {'gcs': 15,
    'sbp': 130,
    'rr': 10,
    'age': 21,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 0,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 0},
   {'tier': 'LOCAL', 'step': 0}),
  ('GCS exactly 13',
   {'gcs': 13,
    'sbp': 130,
    'rr': 16,
    'age': 40,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 1,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 0},
   {'tier': 'TIER1', 'step': 1}),
  ('GCS 12',
   {'gcs': 12,
    'sbp': 130,
    'rr': 16,
    'age': 51,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 0,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 0},
   {'tier': 'TIER1', 'step': 1}),
  ('eight-year-old falls 4 metres',
   {'gcs': 15,
    'sbp': 130,
    'rr': 16,
    'age': 8,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 5,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 0},
   {'tier': 'TIER2', 'step': 3}),
  ('twelve-year-old falls 5 metres',
   {'gcs': 15,
    'sbp': 130,
    'rr': 16,
    'age': 12,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 5,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 0},
   {'tier': 'TIER2', 'step': 3}),
  ('pregnant at 20 weeks',
   {'gcs': 15,
    'sbp': 130,
    'rr': 16,
    'age': 29,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 0,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 20},
   {'tier': 'LOCAL', 'step': 0}),
  ('pregnant at 12 weeks',
   {'gcs': 15,
    'sbp': 130,
    'rr': 16,
    'age': 40,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 0,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 11},
   {'tier': 'LOCAL', 'step': 0}),
  ('pregnant at 24 weeks',
   {'gcs': 15,
    'sbp': 130,
    'rr': 16,
    'age': 31,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 0,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 24},
   {'tier': 'TIER3', 'step': 4})],
 [('uninjured control',
   {'gcs': 15,
    'sbp': 130,
    'rr': 16,
    'age': 32,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 0,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 0},
   {'tier': 'LOCAL', 'step': 0}),
  ('65-year-old with systolic 100',
   {'gcs': 15,
    'sbp': 102,
    'rr': 16,
    'age': 65,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 0,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 0},
   {'tier': 'TIER1', 'step': 1}),
  ('bradypnoea',
   {'gcs': 15,
    'sbp': 130,
    'rr': 8,
    'age': 40,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 0,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 0},
   {'tier': 'TIER1', 'step': 1}),
  ('respiratory rate exactly 10',
   {'gcs': 15,
    'sbp': 130,
    'rr': 10,
    'age': 22,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 0,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 0},
   {'tier': 'LOCAL', 'step': 0}),
  ('GCS exactly 13',
   {'gcs': 13,
    'sbp': 130,
    'rr': 16,
    'age': 40,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 2,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 0},
   {'tier': 'TIER1', 'step': 1}),
  ('GCS 12',
   {'gcs': 12,
    'sbp': 130,
    'rr': 16,
    'age': 52,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 0,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 0},
   {'tier': 'TIER1', 'step': 1}),
  ('eight-year-old falls 4 metres',
   {'gcs': 15,
    'sbp': 130,
    'rr': 16,
    'age': 8,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 4,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 0},
   {'tier': 'TIER2', 'step': 3}),
  ('twelve-year-old falls 5 metres',
   {'gcs': 15,
    'sbp': 130,
    'rr': 16,
    'age': 12,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 5,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 0},
   {'tier': 'TIER2', 'step': 3}),
  ('pregnant at 20 weeks',
   {'gcs': 15,
    'sbp': 130,
    'rr': 16,
    'age': 30,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 0,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 20},
   {'tier': 'LOCAL', 'step': 0}),
  ('pregnant at 12 weeks',
   {'gcs': 15,
    'sbp': 130,
    'rr': 16,
    'age': 40,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 0,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 10},
   {'tier': 'LOCAL', 'step': 0}),
  ('pregnant at 24 weeks',
   {'gcs': 15,
    'sbp': 130,
    'rr': 16,
    'age': 31,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 0,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 24},
   {'tier': 'TIER3', 'step': 4})],
 [('uninjured control',
   {'gcs': 15,
    'sbp': 130,
    'rr': 16,
    'age': 33,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 0,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 0},
   {'tier': 'LOCAL', 'step': 0}),
  ('65-year-old with systolic 100',
   {'gcs': 15,
    'sbp': 103,
    'rr': 16,
    'age': 65,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 0,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 0},
   {'tier': 'TIER1', 'step': 1}),
  ('bradypnoea',
   {'gcs': 15,
    'sbp': 130,
    'rr': 9,
    'age': 40,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 0,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 0},
   {'tier': 'TIER1', 'step': 1}),
  ('respiratory rate exactly 10',
   {'gcs': 15,
    'sbp': 130,
    'rr': 10,
    'age': 23,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 0,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 0},
   {'tier': 'LOCAL', 'step': 0}),
  ('GCS exactly 13',
   {'gcs': 13,
    'sbp': 130,
    'rr': 16,
    'age': 40,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 3,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 0},
   {'tier': 'TIER1', 'step': 1}),
  ('GCS 12',
   {'gcs': 12,
    'sbp': 130,
    'rr': 16,
    'age': 53,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 0,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 0},
   {'tier': 'TIER1', 'step': 1}),
  ('eight-year-old falls 4 metres',
   {'gcs': 15,
    'sbp': 130,
    'rr': 16,
    'age': 8,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 5,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 0},
   {'tier': 'TIER2', 'step': 3}),
  ('twelve-year-old falls 5 metres',
   {'gcs': 15,
    'sbp': 130,
    'rr': 16,
    'age': 12,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 5,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 0},
   {'tier': 'TIER2', 'step': 3}),
  ('pregnant at 20 weeks',
   {'gcs': 15,
    'sbp': 130,
    'rr': 16,
    'age': 31,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 0,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 20},
   {'tier': 'LOCAL', 'step': 0}),
  ('pregnant at 12 weeks',
   {'gcs': 15,
    'sbp': 130,
    'rr': 16,
    'age': 40,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 0,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 9},
   {'tier': 'LOCAL', 'step': 0}),
  ('pregnant at 24 weeks',
   {'gcs': 15,
    'sbp': 130,
    'rr': 16,
    'age': 31,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 0,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 24},
   {'tier': 'TIER3', 'step': 4})],
 [('uninjured control',
   {'gcs': 15,
    'sbp': 130,
    'rr': 16,
    'age': 34,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 0,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 0},
   {'tier': 'LOCAL', 'step': 0}),
  ('65-year-old with systolic 100',
   {'gcs': 15,
    'sbp': 104,
    'rr': 16,
    'age': 65,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 0,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 0},
   {'tier': 'TIER1', 'step': 1}),
  ('bradypnoea',
   {'gcs': 15,
    'sbp': 130,
    'rr': 8,
    'age': 40,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 0,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 0},
   {'tier': 'TIER1', 'step': 1}),
  ('respiratory rate exactly 10',
   {'gcs': 15,
    'sbp': 130,
    'rr': 10,
    'age': 24,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 0,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 0},
   {'tier': 'LOCAL', 'step': 0}),
  ('GCS exactly 13',
   {'gcs': 13,
    'sbp': 130,
    'rr': 16,
    'age': 40,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 4,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 0},
   {'tier': 'TIER1', 'step': 1}),
  ('GCS 12',
   {'gcs': 12,
    'sbp': 130,
    'rr': 16,
    'age': 54,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 0,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 0},
   {'tier': 'TIER1', 'step': 1}),
  ('eight-year-old falls 4 metres',
   {'gcs': 15,
    'sbp': 130,
    'rr': 16,
    'age': 8,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 4,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 0},
   {'tier': 'TIER2', 'step': 3}),
  ('twelve-year-old falls 5 metres',
   {'gcs': 15,
    'sbp': 130,
    'rr': 16,
    'age': 12,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 5,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 0},
   {'tier': 'TIER2', 'step': 3}),
  ('pregnant at 20 weeks',
   {'gcs': 15,
    'sbp': 130,
    'rr': 16,
    'age': 32,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 0,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 20},
   {'tier': 'LOCAL', 'step': 0}),
  ('pregnant at 12 weeks',
   {'gcs': 15,
    'sbp': 130,
    'rr': 16,
    'age': 40,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 0,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 8},
   {'tier': 'LOCAL', 'step': 0}),
  ('pregnant at 24 weeks',
   {'gcs': 15,
    'sbp': 130,
    'rr': 16,
    'age': 31,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 0,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 24},
   {'tier': 'TIER3', 'step': 4})],
 [('uninjured control',
   {'gcs': 15,
    'sbp': 130,
    'rr': 16,
    'age': 35,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 0,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 0},
   {'tier': 'LOCAL', 'step': 0}),
  ('65-year-old with systolic 100',
   {'gcs': 15,
    'sbp': 105,
    'rr': 16,
    'age': 65,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 0,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 0},
   {'tier': 'TIER1', 'step': 1}),
  ('bradypnoea',
   {'gcs': 15,
    'sbp': 130,
    'rr': 9,
    'age': 40,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 0,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 0},
   {'tier': 'TIER1', 'step': 1}),
  ('respiratory rate exactly 10',
   {'gcs': 15,
    'sbp': 130,
    'rr': 10,
    'age': 25,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 0,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 0},
   {'tier': 'LOCAL', 'step': 0}),
  ('GCS exactly 13',
   {'gcs': 13,
    'sbp': 130,
    'rr': 16,
    'age': 40,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 5,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 0},
   {'tier': 'TIER1', 'step': 1}),
  ('GCS 12',
   {'gcs': 12,
    'sbp': 130,
    'rr': 16,
    'age': 55,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 0,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 0},
   {'tier': 'TIER1', 'step': 1}),
  ('eight-year-old falls 4 metres',
   {'gcs': 15,
    'sbp': 130,
    'rr': 16,
    'age': 8,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 5,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 0},
   {'tier': 'TIER2', 'step': 3}),
  ('twelve-year-old falls 5 metres',
   {'gcs': 15,
    'sbp': 130,
    'rr': 16,
    'age': 12,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 5,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 0},
   {'tier': 'TIER2', 'step': 3}),
  ('pregnant at 20 weeks',
   {'gcs': 15,
    'sbp': 130,
    'rr': 16,
    'age': 33,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 0,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 20},
   {'tier': 'LOCAL', 'step': 0}),
  ('pregnant at 12 weeks',
   {'gcs': 15,
    'sbp': 130,
    'rr': 16,
    'age': 40,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 0,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 7},
   {'tier': 'LOCAL', 'step': 0}),
  ('pregnant at 24 weeks',
   {'gcs': 15,
    'sbp': 130,
    'rr': 16,
    'age': 31,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 0,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 24},
   {'tier': 'TIER3', 'step': 4})]]
for label, args, expected in fixtures[N-1]:
    check(label, solve(args), expected)
print(json.dumps({"observations": observations, "passed": all(x["passed"] for x in observations)}, ensure_ascii=False))
raise SystemExit(0 if all(x["passed"] for x in observations) else 1)
Boundary fixtureActualExpectedOutcome
uninjured control{'step': 0, 'tier': 'LOCAL'}{'step': 0, 'tier': 'LOCAL'}Passed
65-year-old with systolic 100{'step': 4, 'tier': 'TIER3'}{'step': 1, 'tier': 'TIER1'}Failed
bradypnoea{'step': 1, 'tier': 'TIER1'}{'step': 1, 'tier': 'TIER1'}Passed
respiratory rate exactly 10{'step': 0, 'tier': 'LOCAL'}{'step': 0, 'tier': 'LOCAL'}Passed
GCS exactly 13{'step': 1, 'tier': 'TIER1'}{'step': 1, 'tier': 'TIER1'}Passed
GCS 12{'step': 1, 'tier': 'TIER1'}{'step': 1, 'tier': 'TIER1'}Passed
eight-year-old falls 4 metres{'step': 3, 'tier': 'TIER2'}{'step': 3, 'tier': 'TIER2'}Passed
twelve-year-old falls 5 metres{'step': 3, 'tier': 'TIER2'}{'step': 3, 'tier': 'TIER2'}Passed
pregnant at 20 weeks{'step': 0, 'tier': 'LOCAL'}{'step': 0, 'tier': 'LOCAL'}Passed
pregnant at 12 weeks{'step': 0, 'tier': 'LOCAL'}{'step': 0, 'tier': 'LOCAL'}Passed
pregnant at 24 weeks{'step': 4, 'tier': 'TIER3'}{'step': 4, 'tier': 'TIER3'}Passed

SHA-256 / 16b5050bc9c9b864ceba6e8a734b45c0f46c70832a875240e0055a4b96f29cc7

2 / The unsuccessful fix

Exit 1
"""Failure Map reference implementation. Python standard library only."""
import json

N = 1
observations = []
def solve(x):
    a = x['age']
    sbp_lim = 110 if a > 65 else 90
    if x['gcs'] <= 13 or x['sbp'] < sbp_lim or x['rr'] < 10 or x['rr'] > 29:
        return {'tier': 'TIER1', 'step': 1}
    if x['penetrating_torso'] or x['flail_chest'] or x['two_long_bone_fx']:
        return {'tier': 'TIER1', 'step': 2}
    fall_lim = 3 if a < 15 else 6
    if x['fall_m'] > fall_lim or x['ejection']:
        return {'tier': 'TIER2', 'step': 3}
    if x['anticoag'] or x['pregnant_weeks'] > 20 or a >= 65:
        return {'tier': 'TIER3', 'step': 4}
    return {'tier': 'LOCAL', 'step': 0}
def check(label, actual, expected):
    observations.append({"check": label, "actual": actual, "expected": expected, "passed": actual == expected})
fixtures = [[('uninjured control',
   {'gcs': 15,
    'sbp': 130,
    'rr': 16,
    'age': 31,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 0,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 0},
   {'tier': 'LOCAL', 'step': 0}),
  ('65-year-old with systolic 100',
   {'gcs': 15,
    'sbp': 101,
    'rr': 16,
    'age': 65,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 0,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 0},
   {'tier': 'TIER1', 'step': 1}),
  ('bradypnoea',
   {'gcs': 15,
    'sbp': 130,
    'rr': 9,
    'age': 40,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 0,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 0},
   {'tier': 'TIER1', 'step': 1}),
  ('respiratory rate exactly 10',
   {'gcs': 15,
    'sbp': 130,
    'rr': 10,
    'age': 21,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 0,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 0},
   {'tier': 'LOCAL', 'step': 0}),
  ('GCS exactly 13',
   {'gcs': 13,
    'sbp': 130,
    'rr': 16,
    'age': 40,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 1,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 0},
   {'tier': 'TIER1', 'step': 1}),
  ('GCS 12',
   {'gcs': 12,
    'sbp': 130,
    'rr': 16,
    'age': 51,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 0,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 0},
   {'tier': 'TIER1', 'step': 1}),
  ('eight-year-old falls 4 metres',
   {'gcs': 15,
    'sbp': 130,
    'rr': 16,
    'age': 8,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 5,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 0},
   {'tier': 'TIER2', 'step': 3}),
  ('twelve-year-old falls 5 metres',
   {'gcs': 15,
    'sbp': 130,
    'rr': 16,
    'age': 12,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 5,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 0},
   {'tier': 'TIER2', 'step': 3}),
  ('pregnant at 20 weeks',
   {'gcs': 15,
    'sbp': 130,
    'rr': 16,
    'age': 29,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 0,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 20},
   {'tier': 'LOCAL', 'step': 0}),
  ('pregnant at 12 weeks',
   {'gcs': 15,
    'sbp': 130,
    'rr': 16,
    'age': 40,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 0,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 11},
   {'tier': 'LOCAL', 'step': 0}),
  ('pregnant at 24 weeks',
   {'gcs': 15,
    'sbp': 130,
    'rr': 16,
    'age': 31,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 0,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 24},
   {'tier': 'TIER3', 'step': 4})],
 [('uninjured control',
   {'gcs': 15,
    'sbp': 130,
    'rr': 16,
    'age': 32,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 0,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 0},
   {'tier': 'LOCAL', 'step': 0}),
  ('65-year-old with systolic 100',
   {'gcs': 15,
    'sbp': 102,
    'rr': 16,
    'age': 65,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 0,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 0},
   {'tier': 'TIER1', 'step': 1}),
  ('bradypnoea',
   {'gcs': 15,
    'sbp': 130,
    'rr': 8,
    'age': 40,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 0,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 0},
   {'tier': 'TIER1', 'step': 1}),
  ('respiratory rate exactly 10',
   {'gcs': 15,
    'sbp': 130,
    'rr': 10,
    'age': 22,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 0,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 0},
   {'tier': 'LOCAL', 'step': 0}),
  ('GCS exactly 13',
   {'gcs': 13,
    'sbp': 130,
    'rr': 16,
    'age': 40,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 2,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 0},
   {'tier': 'TIER1', 'step': 1}),
  ('GCS 12',
   {'gcs': 12,
    'sbp': 130,
    'rr': 16,
    'age': 52,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 0,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 0},
   {'tier': 'TIER1', 'step': 1}),
  ('eight-year-old falls 4 metres',
   {'gcs': 15,
    'sbp': 130,
    'rr': 16,
    'age': 8,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 4,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 0},
   {'tier': 'TIER2', 'step': 3}),
  ('twelve-year-old falls 5 metres',
   {'gcs': 15,
    'sbp': 130,
    'rr': 16,
    'age': 12,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 5,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 0},
   {'tier': 'TIER2', 'step': 3}),
  ('pregnant at 20 weeks',
   {'gcs': 15,
    'sbp': 130,
    'rr': 16,
    'age': 30,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 0,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 20},
   {'tier': 'LOCAL', 'step': 0}),
  ('pregnant at 12 weeks',
   {'gcs': 15,
    'sbp': 130,
    'rr': 16,
    'age': 40,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 0,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 10},
   {'tier': 'LOCAL', 'step': 0}),
  ('pregnant at 24 weeks',
   {'gcs': 15,
    'sbp': 130,
    'rr': 16,
    'age': 31,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 0,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 24},
   {'tier': 'TIER3', 'step': 4})],
 [('uninjured control',
   {'gcs': 15,
    'sbp': 130,
    'rr': 16,
    'age': 33,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 0,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 0},
   {'tier': 'LOCAL', 'step': 0}),
  ('65-year-old with systolic 100',
   {'gcs': 15,
    'sbp': 103,
    'rr': 16,
    'age': 65,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 0,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 0},
   {'tier': 'TIER1', 'step': 1}),
  ('bradypnoea',
   {'gcs': 15,
    'sbp': 130,
    'rr': 9,
    'age': 40,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 0,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 0},
   {'tier': 'TIER1', 'step': 1}),
  ('respiratory rate exactly 10',
   {'gcs': 15,
    'sbp': 130,
    'rr': 10,
    'age': 23,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 0,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 0},
   {'tier': 'LOCAL', 'step': 0}),
  ('GCS exactly 13',
   {'gcs': 13,
    'sbp': 130,
    'rr': 16,
    'age': 40,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 3,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 0},
   {'tier': 'TIER1', 'step': 1}),
  ('GCS 12',
   {'gcs': 12,
    'sbp': 130,
    'rr': 16,
    'age': 53,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 0,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 0},
   {'tier': 'TIER1', 'step': 1}),
  ('eight-year-old falls 4 metres',
   {'gcs': 15,
    'sbp': 130,
    'rr': 16,
    'age': 8,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 5,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 0},
   {'tier': 'TIER2', 'step': 3}),
  ('twelve-year-old falls 5 metres',
   {'gcs': 15,
    'sbp': 130,
    'rr': 16,
    'age': 12,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 5,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 0},
   {'tier': 'TIER2', 'step': 3}),
  ('pregnant at 20 weeks',
   {'gcs': 15,
    'sbp': 130,
    'rr': 16,
    'age': 31,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 0,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 20},
   {'tier': 'LOCAL', 'step': 0}),
  ('pregnant at 12 weeks',
   {'gcs': 15,
    'sbp': 130,
    'rr': 16,
    'age': 40,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 0,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 9},
   {'tier': 'LOCAL', 'step': 0}),
  ('pregnant at 24 weeks',
   {'gcs': 15,
    'sbp': 130,
    'rr': 16,
    'age': 31,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 0,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 24},
   {'tier': 'TIER3', 'step': 4})],
 [('uninjured control',
   {'gcs': 15,
    'sbp': 130,
    'rr': 16,
    'age': 34,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 0,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 0},
   {'tier': 'LOCAL', 'step': 0}),
  ('65-year-old with systolic 100',
   {'gcs': 15,
    'sbp': 104,
    'rr': 16,
    'age': 65,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 0,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 0},
   {'tier': 'TIER1', 'step': 1}),
  ('bradypnoea',
   {'gcs': 15,
    'sbp': 130,
    'rr': 8,
    'age': 40,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 0,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 0},
   {'tier': 'TIER1', 'step': 1}),
  ('respiratory rate exactly 10',
   {'gcs': 15,
    'sbp': 130,
    'rr': 10,
    'age': 24,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 0,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 0},
   {'tier': 'LOCAL', 'step': 0}),
  ('GCS exactly 13',
   {'gcs': 13,
    'sbp': 130,
    'rr': 16,
    'age': 40,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 4,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 0},
   {'tier': 'TIER1', 'step': 1}),
  ('GCS 12',
   {'gcs': 12,
    'sbp': 130,
    'rr': 16,
    'age': 54,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 0,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 0},
   {'tier': 'TIER1', 'step': 1}),
  ('eight-year-old falls 4 metres',
   {'gcs': 15,
    'sbp': 130,
    'rr': 16,
    'age': 8,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 4,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 0},
   {'tier': 'TIER2', 'step': 3}),
  ('twelve-year-old falls 5 metres',
   {'gcs': 15,
    'sbp': 130,
    'rr': 16,
    'age': 12,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 5,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 0},
   {'tier': 'TIER2', 'step': 3}),
  ('pregnant at 20 weeks',
   {'gcs': 15,
    'sbp': 130,
    'rr': 16,
    'age': 32,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 0,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 20},
   {'tier': 'LOCAL', 'step': 0}),
  ('pregnant at 12 weeks',
   {'gcs': 15,
    'sbp': 130,
    'rr': 16,
    'age': 40,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 0,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 8},
   {'tier': 'LOCAL', 'step': 0}),
  ('pregnant at 24 weeks',
   {'gcs': 15,
    'sbp': 130,
    'rr': 16,
    'age': 31,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 0,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 24},
   {'tier': 'TIER3', 'step': 4})],
 [('uninjured control',
   {'gcs': 15,
    'sbp': 130,
    'rr': 16,
    'age': 35,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 0,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 0},
   {'tier': 'LOCAL', 'step': 0}),
  ('65-year-old with systolic 100',
   {'gcs': 15,
    'sbp': 105,
    'rr': 16,
    'age': 65,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 0,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 0},
   {'tier': 'TIER1', 'step': 1}),
  ('bradypnoea',
   {'gcs': 15,
    'sbp': 130,
    'rr': 9,
    'age': 40,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 0,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 0},
   {'tier': 'TIER1', 'step': 1}),
  ('respiratory rate exactly 10',
   {'gcs': 15,
    'sbp': 130,
    'rr': 10,
    'age': 25,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 0,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 0},
   {'tier': 'LOCAL', 'step': 0}),
  ('GCS exactly 13',
   {'gcs': 13,
    'sbp': 130,
    'rr': 16,
    'age': 40,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 5,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 0},
   {'tier': 'TIER1', 'step': 1}),
  ('GCS 12',
   {'gcs': 12,
    'sbp': 130,
    'rr': 16,
    'age': 55,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 0,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 0},
   {'tier': 'TIER1', 'step': 1}),
  ('eight-year-old falls 4 metres',
   {'gcs': 15,
    'sbp': 130,
    'rr': 16,
    'age': 8,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 5,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 0},
   {'tier': 'TIER2', 'step': 3}),
  ('twelve-year-old falls 5 metres',
   {'gcs': 15,
    'sbp': 130,
    'rr': 16,
    'age': 12,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 5,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 0},
   {'tier': 'TIER2', 'step': 3}),
  ('pregnant at 20 weeks',
   {'gcs': 15,
    'sbp': 130,
    'rr': 16,
    'age': 33,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 0,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 20},
   {'tier': 'LOCAL', 'step': 0}),
  ('pregnant at 12 weeks',
   {'gcs': 15,
    'sbp': 130,
    'rr': 16,
    'age': 40,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 0,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 7},
   {'tier': 'LOCAL', 'step': 0}),
  ('pregnant at 24 weeks',
   {'gcs': 15,
    'sbp': 130,
    'rr': 16,
    'age': 31,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 0,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 24},
   {'tier': 'TIER3', 'step': 4})]]
for label, args, expected in fixtures[N-1]:
    check(label, solve(args), expected)
print(json.dumps({"observations": observations, "passed": all(x["passed"] for x in observations)}, ensure_ascii=False))
raise SystemExit(0 if all(x["passed"] for x in observations) else 1)
Boundary fixtureActualExpectedOutcome
uninjured control{'step': 0, 'tier': 'LOCAL'}{'step': 0, 'tier': 'LOCAL'}Passed
65-year-old with systolic 100{'step': 4, 'tier': 'TIER3'}{'step': 1, 'tier': 'TIER1'}Failed
bradypnoea{'step': 1, 'tier': 'TIER1'}{'step': 1, 'tier': 'TIER1'}Passed
respiratory rate exactly 10{'step': 0, 'tier': 'LOCAL'}{'step': 0, 'tier': 'LOCAL'}Passed
GCS exactly 13{'step': 1, 'tier': 'TIER1'}{'step': 1, 'tier': 'TIER1'}Passed
GCS 12{'step': 1, 'tier': 'TIER1'}{'step': 1, 'tier': 'TIER1'}Passed
eight-year-old falls 4 metres{'step': 3, 'tier': 'TIER2'}{'step': 3, 'tier': 'TIER2'}Passed
twelve-year-old falls 5 metres{'step': 3, 'tier': 'TIER2'}{'step': 3, 'tier': 'TIER2'}Passed
pregnant at 20 weeks{'step': 0, 'tier': 'LOCAL'}{'step': 0, 'tier': 'LOCAL'}Passed
pregnant at 12 weeks{'step': 0, 'tier': 'LOCAL'}{'step': 0, 'tier': 'LOCAL'}Passed
pregnant at 24 weeks{'step': 4, 'tier': 'TIER3'}{'step': 4, 'tier': 'TIER3'}Passed

SHA-256 / 127db1219cbfe8acc11a89b1c43a96ffcdec9bd7ebf744801abdc6f477c02476

3 / The verified repair

Exit 0
"""Failure Map reference implementation. Python standard library only."""
import json

N = 1
observations = []
def solve(x):
    a = x['age']
    sbp_lim = 110 if a >= 65 else 90
    if x['gcs'] <= 13 or x['sbp'] < sbp_lim or x['rr'] < 10 or x['rr'] > 29:
        return {'tier': 'TIER1', 'step': 1}
    if x['penetrating_torso'] or x['flail_chest'] or x['two_long_bone_fx']:
        return {'tier': 'TIER1', 'step': 2}
    fall_lim = 3 if a < 15 else 6
    if x['fall_m'] > fall_lim or x['ejection']:
        return {'tier': 'TIER2', 'step': 3}
    if x['anticoag'] or x['pregnant_weeks'] > 20 or a >= 65:
        return {'tier': 'TIER3', 'step': 4}
    return {'tier': 'LOCAL', 'step': 0}
def check(label, actual, expected):
    observations.append({"check": label, "actual": actual, "expected": expected, "passed": actual == expected})
fixtures = [[('uninjured control',
   {'gcs': 15,
    'sbp': 130,
    'rr': 16,
    'age': 31,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 0,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 0},
   {'tier': 'LOCAL', 'step': 0}),
  ('65-year-old with systolic 100',
   {'gcs': 15,
    'sbp': 101,
    'rr': 16,
    'age': 65,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 0,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 0},
   {'tier': 'TIER1', 'step': 1}),
  ('bradypnoea',
   {'gcs': 15,
    'sbp': 130,
    'rr': 9,
    'age': 40,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 0,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 0},
   {'tier': 'TIER1', 'step': 1}),
  ('respiratory rate exactly 10',
   {'gcs': 15,
    'sbp': 130,
    'rr': 10,
    'age': 21,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 0,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 0},
   {'tier': 'LOCAL', 'step': 0}),
  ('GCS exactly 13',
   {'gcs': 13,
    'sbp': 130,
    'rr': 16,
    'age': 40,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 1,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 0},
   {'tier': 'TIER1', 'step': 1}),
  ('GCS 12',
   {'gcs': 12,
    'sbp': 130,
    'rr': 16,
    'age': 51,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 0,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 0},
   {'tier': 'TIER1', 'step': 1}),
  ('eight-year-old falls 4 metres',
   {'gcs': 15,
    'sbp': 130,
    'rr': 16,
    'age': 8,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 5,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 0},
   {'tier': 'TIER2', 'step': 3}),
  ('twelve-year-old falls 5 metres',
   {'gcs': 15,
    'sbp': 130,
    'rr': 16,
    'age': 12,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 5,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 0},
   {'tier': 'TIER2', 'step': 3}),
  ('pregnant at 20 weeks',
   {'gcs': 15,
    'sbp': 130,
    'rr': 16,
    'age': 29,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 0,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 20},
   {'tier': 'LOCAL', 'step': 0}),
  ('pregnant at 12 weeks',
   {'gcs': 15,
    'sbp': 130,
    'rr': 16,
    'age': 40,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 0,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 11},
   {'tier': 'LOCAL', 'step': 0}),
  ('pregnant at 24 weeks',
   {'gcs': 15,
    'sbp': 130,
    'rr': 16,
    'age': 31,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 0,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 24},
   {'tier': 'TIER3', 'step': 4})],
 [('uninjured control',
   {'gcs': 15,
    'sbp': 130,
    'rr': 16,
    'age': 32,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 0,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 0},
   {'tier': 'LOCAL', 'step': 0}),
  ('65-year-old with systolic 100',
   {'gcs': 15,
    'sbp': 102,
    'rr': 16,
    'age': 65,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 0,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 0},
   {'tier': 'TIER1', 'step': 1}),
  ('bradypnoea',
   {'gcs': 15,
    'sbp': 130,
    'rr': 8,
    'age': 40,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 0,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 0},
   {'tier': 'TIER1', 'step': 1}),
  ('respiratory rate exactly 10',
   {'gcs': 15,
    'sbp': 130,
    'rr': 10,
    'age': 22,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 0,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 0},
   {'tier': 'LOCAL', 'step': 0}),
  ('GCS exactly 13',
   {'gcs': 13,
    'sbp': 130,
    'rr': 16,
    'age': 40,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 2,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 0},
   {'tier': 'TIER1', 'step': 1}),
  ('GCS 12',
   {'gcs': 12,
    'sbp': 130,
    'rr': 16,
    'age': 52,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 0,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 0},
   {'tier': 'TIER1', 'step': 1}),
  ('eight-year-old falls 4 metres',
   {'gcs': 15,
    'sbp': 130,
    'rr': 16,
    'age': 8,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 4,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 0},
   {'tier': 'TIER2', 'step': 3}),
  ('twelve-year-old falls 5 metres',
   {'gcs': 15,
    'sbp': 130,
    'rr': 16,
    'age': 12,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 5,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 0},
   {'tier': 'TIER2', 'step': 3}),
  ('pregnant at 20 weeks',
   {'gcs': 15,
    'sbp': 130,
    'rr': 16,
    'age': 30,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 0,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 20},
   {'tier': 'LOCAL', 'step': 0}),
  ('pregnant at 12 weeks',
   {'gcs': 15,
    'sbp': 130,
    'rr': 16,
    'age': 40,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 0,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 10},
   {'tier': 'LOCAL', 'step': 0}),
  ('pregnant at 24 weeks',
   {'gcs': 15,
    'sbp': 130,
    'rr': 16,
    'age': 31,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 0,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 24},
   {'tier': 'TIER3', 'step': 4})],
 [('uninjured control',
   {'gcs': 15,
    'sbp': 130,
    'rr': 16,
    'age': 33,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 0,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 0},
   {'tier': 'LOCAL', 'step': 0}),
  ('65-year-old with systolic 100',
   {'gcs': 15,
    'sbp': 103,
    'rr': 16,
    'age': 65,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 0,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 0},
   {'tier': 'TIER1', 'step': 1}),
  ('bradypnoea',
   {'gcs': 15,
    'sbp': 130,
    'rr': 9,
    'age': 40,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 0,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 0},
   {'tier': 'TIER1', 'step': 1}),
  ('respiratory rate exactly 10',
   {'gcs': 15,
    'sbp': 130,
    'rr': 10,
    'age': 23,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 0,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 0},
   {'tier': 'LOCAL', 'step': 0}),
  ('GCS exactly 13',
   {'gcs': 13,
    'sbp': 130,
    'rr': 16,
    'age': 40,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 3,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 0},
   {'tier': 'TIER1', 'step': 1}),
  ('GCS 12',
   {'gcs': 12,
    'sbp': 130,
    'rr': 16,
    'age': 53,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 0,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 0},
   {'tier': 'TIER1', 'step': 1}),
  ('eight-year-old falls 4 metres',
   {'gcs': 15,
    'sbp': 130,
    'rr': 16,
    'age': 8,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 5,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 0},
   {'tier': 'TIER2', 'step': 3}),
  ('twelve-year-old falls 5 metres',
   {'gcs': 15,
    'sbp': 130,
    'rr': 16,
    'age': 12,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 5,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 0},
   {'tier': 'TIER2', 'step': 3}),
  ('pregnant at 20 weeks',
   {'gcs': 15,
    'sbp': 130,
    'rr': 16,
    'age': 31,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 0,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 20},
   {'tier': 'LOCAL', 'step': 0}),
  ('pregnant at 12 weeks',
   {'gcs': 15,
    'sbp': 130,
    'rr': 16,
    'age': 40,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 0,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 9},
   {'tier': 'LOCAL', 'step': 0}),
  ('pregnant at 24 weeks',
   {'gcs': 15,
    'sbp': 130,
    'rr': 16,
    'age': 31,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 0,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 24},
   {'tier': 'TIER3', 'step': 4})],
 [('uninjured control',
   {'gcs': 15,
    'sbp': 130,
    'rr': 16,
    'age': 34,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 0,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 0},
   {'tier': 'LOCAL', 'step': 0}),
  ('65-year-old with systolic 100',
   {'gcs': 15,
    'sbp': 104,
    'rr': 16,
    'age': 65,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 0,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 0},
   {'tier': 'TIER1', 'step': 1}),
  ('bradypnoea',
   {'gcs': 15,
    'sbp': 130,
    'rr': 8,
    'age': 40,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 0,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 0},
   {'tier': 'TIER1', 'step': 1}),
  ('respiratory rate exactly 10',
   {'gcs': 15,
    'sbp': 130,
    'rr': 10,
    'age': 24,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 0,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 0},
   {'tier': 'LOCAL', 'step': 0}),
  ('GCS exactly 13',
   {'gcs': 13,
    'sbp': 130,
    'rr': 16,
    'age': 40,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 4,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 0},
   {'tier': 'TIER1', 'step': 1}),
  ('GCS 12',
   {'gcs': 12,
    'sbp': 130,
    'rr': 16,
    'age': 54,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 0,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 0},
   {'tier': 'TIER1', 'step': 1}),
  ('eight-year-old falls 4 metres',
   {'gcs': 15,
    'sbp': 130,
    'rr': 16,
    'age': 8,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 4,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 0},
   {'tier': 'TIER2', 'step': 3}),
  ('twelve-year-old falls 5 metres',
   {'gcs': 15,
    'sbp': 130,
    'rr': 16,
    'age': 12,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 5,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 0},
   {'tier': 'TIER2', 'step': 3}),
  ('pregnant at 20 weeks',
   {'gcs': 15,
    'sbp': 130,
    'rr': 16,
    'age': 32,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 0,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 20},
   {'tier': 'LOCAL', 'step': 0}),
  ('pregnant at 12 weeks',
   {'gcs': 15,
    'sbp': 130,
    'rr': 16,
    'age': 40,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 0,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 8},
   {'tier': 'LOCAL', 'step': 0}),
  ('pregnant at 24 weeks',
   {'gcs': 15,
    'sbp': 130,
    'rr': 16,
    'age': 31,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 0,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 24},
   {'tier': 'TIER3', 'step': 4})],
 [('uninjured control',
   {'gcs': 15,
    'sbp': 130,
    'rr': 16,
    'age': 35,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 0,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 0},
   {'tier': 'LOCAL', 'step': 0}),
  ('65-year-old with systolic 100',
   {'gcs': 15,
    'sbp': 105,
    'rr': 16,
    'age': 65,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 0,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 0},
   {'tier': 'TIER1', 'step': 1}),
  ('bradypnoea',
   {'gcs': 15,
    'sbp': 130,
    'rr': 9,
    'age': 40,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 0,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 0},
   {'tier': 'TIER1', 'step': 1}),
  ('respiratory rate exactly 10',
   {'gcs': 15,
    'sbp': 130,
    'rr': 10,
    'age': 25,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 0,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 0},
   {'tier': 'LOCAL', 'step': 0}),
  ('GCS exactly 13',
   {'gcs': 13,
    'sbp': 130,
    'rr': 16,
    'age': 40,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 5,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 0},
   {'tier': 'TIER1', 'step': 1}),
  ('GCS 12',
   {'gcs': 12,
    'sbp': 130,
    'rr': 16,
    'age': 55,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 0,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 0},
   {'tier': 'TIER1', 'step': 1}),
  ('eight-year-old falls 4 metres',
   {'gcs': 15,
    'sbp': 130,
    'rr': 16,
    'age': 8,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 5,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 0},
   {'tier': 'TIER2', 'step': 3}),
  ('twelve-year-old falls 5 metres',
   {'gcs': 15,
    'sbp': 130,
    'rr': 16,
    'age': 12,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 5,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 0},
   {'tier': 'TIER2', 'step': 3}),
  ('pregnant at 20 weeks',
   {'gcs': 15,
    'sbp': 130,
    'rr': 16,
    'age': 33,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 0,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 20},
   {'tier': 'LOCAL', 'step': 0}),
  ('pregnant at 12 weeks',
   {'gcs': 15,
    'sbp': 130,
    'rr': 16,
    'age': 40,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 0,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 7},
   {'tier': 'LOCAL', 'step': 0}),
  ('pregnant at 24 weeks',
   {'gcs': 15,
    'sbp': 130,
    'rr': 16,
    'age': 31,
    'penetrating_torso': False,
    'flail_chest': False,
    'two_long_bone_fx': False,
    'fall_m': 0,
    'ejection': False,
    'anticoag': False,
    'pregnant_weeks': 24},
   {'tier': 'TIER3', 'step': 4})]]
for label, args, expected in fixtures[N-1]:
    check(label, solve(args), expected)
print(json.dumps({"observations": observations, "passed": all(x["passed"] for x in observations)}, ensure_ascii=False))
raise SystemExit(0 if all(x["passed"] for x in observations) else 1)
Boundary fixtureActualExpectedOutcome
uninjured control{'step': 0, 'tier': 'LOCAL'}{'step': 0, 'tier': 'LOCAL'}Passed
65-year-old with systolic 100{'step': 1, 'tier': 'TIER1'}{'step': 1, 'tier': 'TIER1'}Passed
bradypnoea{'step': 1, 'tier': 'TIER1'}{'step': 1, 'tier': 'TIER1'}Passed
respiratory rate exactly 10{'step': 0, 'tier': 'LOCAL'}{'step': 0, 'tier': 'LOCAL'}Passed
GCS exactly 13{'step': 1, 'tier': 'TIER1'}{'step': 1, 'tier': 'TIER1'}Passed
GCS 12{'step': 1, 'tier': 'TIER1'}{'step': 1, 'tier': 'TIER1'}Passed
eight-year-old falls 4 metres{'step': 3, 'tier': 'TIER2'}{'step': 3, 'tier': 'TIER2'}Passed
twelve-year-old falls 5 metres{'step': 3, 'tier': 'TIER2'}{'step': 3, 'tier': 'TIER2'}Passed
pregnant at 20 weeks{'step': 0, 'tier': 'LOCAL'}{'step': 0, 'tier': 'LOCAL'}Passed
pregnant at 12 weeks{'step': 0, 'tier': 'LOCAL'}{'step': 0, 'tier': 'LOCAL'}Passed
pregnant at 24 weeks{'step': 4, 'tier': 'TIER3'}{'step': 4, 'tier': 'TIER3'}Passed

SHA-256 / e5c106fd1a90286487a1e5d4a52875edee58c04d9ad810f8056728ed997f7e4a

Verification & scope

A deterministic toy software model with explicitly stipulated thresholds and formulas; it is not clinical guidance, not a validated medical calculator, and makes no claim of conformance to any published protocol. Numbered variants vary patient and order inputs. This reproducer isolates one failure mechanism. Results cover the supplied fixtures. Variants within a family share a test contract and should remain grouped when constructing evaluation splits. Related mechanisms with a shared evaluation_group must also remain together; these controlled models are not independent production incidents.

Observations recorded using Python 3.12.14 at 2026-09-29T14:47:26.499496+00:00.

Case digest / 69bc33db357cf11484f92d87f2a1505d7e47a8e1814737772d1341e615221ef7