Ambulance crew assessment of trauma severity and alerting practice for trauma patients brought to a general hospital.

Abstract

Ambulance crews may alert hospitals for patients who are severely unwell. This allows the hospital time to prepare space and equipment, and to assemble an appropriate clinical team to receive and manage the patient immediately on arrival. Over and under alerting by ambulance crews is to be avoided to avoid complacency on one hand, and inadequate reception of severely injured patients on the other. There are currently no formal guidelines for the ambulance service to alert hospitals in appropriate cases. To describe the current alerting practice for trauma patients by ambulance crews to a large urban hospital. Details of each trauma alert for the hospital for the year 2000 were identified. The Injury Severity Score (ISS) was determined for all trauma patients who were eligible for inclusion into the Trauma Audit Research Network (TARN) for the same year. The two populations were compared. There were 145 trauma patients for whom an alert was made during the year 2000, and there were 504 patients eligible for inclusion into TARN. Ten percent (49) of the TARN patients had an ISS > 15. Twenty-five percent (35/135) of the trauma patients with alerts had been entered into TARN. Seventy-five percent (100/135) of the trauma patients with alerts did not meet the criteria for inclusion into TARN. Forty-three percent (15/35) of the trauma patients with alerts who appeared in TARN had an ISS > 15 (11% of all trauma alerts). Thirty-four TARN-eligible patients with an ISS > 15 were not the subject of a hospital alert. The majority of patients with major trauma (ISS > 15) were not the subject of a hospital alert by the ambulance service. Seventy-five percent of the patients who were the subject of an alert were not eligible for inclusion into TARN, implying that they did not have serious injury. Pre-hospital trauma severity assessment needs developing with appropriate ambulance protocols, to ensure appropriate alert calls.