Paramedic and Surgeon Views on Trauma Surgical Readiness: Implications for Guideline Implementation

Abstract

Centers for disease control (CDC) Guidelines for Field Triage are effective when proper implementation by EMS personnel is paired with surgeon willingness to care for trauma victims. We hypothesized that in a state with an immature trauma system, a discrepancy exists between medic and surgeon perception of surgical readiness, coinciding with inconsistent implementation of protocols. Surveys were conducted among medics and general surgeons. Destination protocols, trauma center locations, surgeon readiness, and interest in trauma were assessed. A standard clinical trauma scenario was also used. Surgeon willingness to operate is not affected by working outside of trauma centers or interest in trauma. Medics working far from trauma centers are less confident in local surgeon's willingness to operate and less likely to have destination protocols. Trauma center proximity affects medic perception of surgeon willingness to operate, but mere presence of general surgeons does not. In a trauma scenario, surgeon willingness to operate was related to medic perception but not action. In rural states, most surgeons do not work in trauma centers and most medics do not work near them. Although most responding surgeons indicate willingness to operate, medics are confident of such willingness only half the time. This disparity results in inconsistent use of the CDC guidelines. Although most medics report protocols for destination determination, nearly one-fourth of victims are taken to the geographically closest centers, sometimes with no surgeon at all. Efforts at medic training, enhancing surgeon readiness, and alignment of goals are necessary for the CDC Guidelines to be effective.