The role of emergency medical service providers in the decision-making process of prehospital trauma triage

Eveline A J Van Rein,Mark Van Heijl,F Cumhur Oner,Rob A Lichtveld,Koen W W Lansink,Said Sadiqi,Luke P H Leenen,Risco Van Vliet

doi:10.1007/s00068-018-1006-8

Abstract

PurposeSeverely injured patients should be treated at higher-level trauma centres, to improve chances of survival and avert life-long disabilities. Emergency medical service (EMS) providers must try to determine injury severity on-scene, using a prehospital trauma triage protocol, and decide the most appropriate type of trauma centre. The objective of this study is to investigate the role of EMS provider judgment in the prehospital triage process of trauma patients, by analysing the compliance rate to the protocol and administering a questionnaire among EMS providers.MethodsAll trauma patients transported to a trauma centre in two different regions of the Netherlands were analysed. Compliance rate was based on the number of patients meeting the triage criteria and transported to the corresponding level trauma centre. The questionnaire was administered among EMS providers. Descriptive statistics were used to analyse the data.ResultsFor adult patients, the compliance rate to the level I criteria of the triage protocol was 72% in Central Netherlands and 42% in Brabant. For paediatric patients, this was 63% and 38% in Central Netherlands and Brabant, respectively. The judgment on injury severity was mostly based on the injury-type criteria. Additionally, the distance to a level I trauma centre influenced the decision for destination facility in the Brabant region.ConclusionThe compliance rate varied between regions. Improvement of prehospital trauma triage depends on the accuracy of the protocol and compliance rate. A new protocol, including EMS provider judgment, might be the key to improvement in the prehospital trauma triage quality.

Highlights

Prehospital trauma triage is of vital importance to ensure transport to a trauma centre with the appropriate level of care for trauma patients
A prehospital trauma triage protocol is in place to help emergency medical service (EMS) providers discriminate between patients with and without severe injuries, and decide the most appropriate type of trauma centre [4, 5]
This study consists of two parts: (1) an evaluation of compliance to the prehospital trauma triage protocol in a prospective cohort, and (2) a survey, both performed in two regions of the Netherlands: Central Netherlands and Brabant

Summary

Introduction

Prehospital trauma triage is of vital importance to ensure transport to a trauma centre with the appropriate level of care for trauma patients. Patients with severe injuries should be treated at higher level trauma centres, to reduce mortality and morbidity. Patients without severe injuries should be transported to a lower level facility, to reduce burden on the higher level trauma centres’ unnecessary costs [1,2,3]. A prehospital trauma triage protocol is in place to help emergency medical service (EMS) providers discriminate between patients with and without severe injuries, and decide the most appropriate type of trauma centre [4, 5]. Others found the judgment of EMS providers to be less accurate [5, 10]

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