Abstract
BackgroundIn The Netherlands, standard prehospital trauma care is provided by emergency medical services and can be supplemented with advanced trauma care by Mobile Medical Teams. Due to observed over and undertriage in the dispatch of the Mobile Medical Team for major trauma patients, the accuracy of the dispatch criteria has been disputed. In order to obtain recommendations to invigorate the dispatch criteria, this study aimed at reaching consensus in expert opinion on the question; which acute trauma patient is in need of care by a Mobile Medical Team? In this paper we describe the protocol of the DENIM study (a Delphi-procedure on the identification of prehospital trauma patients in need of care by Mobile Medical Teams).MethodsA national three round digital Delphi study will be conducted to reach consensus. Literature was explored for relevant topics. After agreement on the themes of interest, the steering committee will construct questions for the first round. In total, 120 panellists with the following backgrounds; Mobile Medical Team physicians and nurses, trauma surgeons, ambulance nurses, emergency medical operators will be invited to participate. Group opinion will be fed back between each round that follows, allowing the panellists to revise their previous opinions and so, converge towards group consensus.DiscussionSuccessful prehospital treatment of trauma patients greatly depends on the autonomous decisions made by the different professionals along the chain of prehospital trauma care. Trauma patients in need of care by the Mobile Medical Team need to be identified by those professionals in order to invigorate deployment criteria and improve trauma care. The Delphi technique is used because it allows for group consensus to be reached in a systematic and anonymous fashion amongst experts in the field of trauma care. The anonymous nature of the Delphi allows all experts to state their opinion whilst eliminating the bias of dominant and/or hierarchical individuals on group opinion.
Highlights
In The Netherlands, standard prehospital trauma care is provided by emergency medical services and can be supplemented with advanced trauma care by Mobile Medical Teams
In The Netherlands standard prehospital trauma care is provided by emergency medical services (EMS)
In most of the cases the Mobile Medical Team (MMT) physician accompanies the patient to the hospital in the EMS road ambulance and in 5-20% of the cases the trauma patient is transported by the MMT in the helicopter
Summary
In The Netherlands, standard prehospital trauma care is provided by emergency medical services and can be supplemented with advanced trauma care by Mobile Medical Teams. In The Netherlands standard prehospital trauma care is provided by emergency medical services (EMS). Another study in the same cohort of dispatches showed that 21% of all cancellations of this MMT concerned major trauma patients [5] This may be interpreted as undertriage, as this patient category is thought to benefit most by the prehospital assistance of the MMT. Differences in interpretation and application of the MMT dispatch and cancellation criteria by emergency medical personnel may be an underlying cause Several reasons for this phenomenon can be listed such as regional differences in working culture (and familiarity with MMT care), professional autonomy of care takers in all involved disciplines (adherence to guidelines) and a difference in trauma-related knowledge and/or exposure.
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