Long-Term Evaluation of Prehospital Trauma Patient Triage in a Large Urban Area*

Abstract

To evaluate emergency medical technician (EMT) compliance after introduction of trauma patient triage protocols to level I or II trauma centers in a major urban area. A population-based cohort of all trauma victims transported from 1994 to 2001 was assembled. Triage protocols based on the Prehospital Index and high-velocity impact were introduced in July of 1995. Two sets of criteria were developed, one for patients intended specifically for the level I trauma centers and another for patients intended to either level I or II centers. Trauma patients having met triage criteria were identified and the type of hospital to which the patient was taken was compared to that expected by the protocols. Overall, 16,356 patients met trauma triage criteria for direct transport to a trauma center (level I or II) during the 7 years under study. In the 10 months prior to implementation of trauma triage protocols, 57% of these patients were directly transported to appropriate level centers. Following protocol implementation, compliance rose to 80% (p < 0.001). 2 years following protocol implementation, the appropriate triage rate reached 91% (p < 0.001). For the specific protocol pertaining to the most severely injured intended for the level I centers, compliance was lower and took longer to improve. A systematic approach to triage of severely injured trauma patients in the prehospital setting is possible to implement and is appropriately applied by EMTs.