Abstract
The emergency medical services (EMS) cover initiatives and services established to provide essential medical assistance in situations of acute illness. Triage-methods for systematic prioritizing of patients according to how urgent patients need care, including triage of requests of acute medical treatment, are adopted in hospitals as well as in the pre-hospital settings. This systematic review searched to identify available research on the effects of validated triage systems for use in the pre-hospital EMS on health outcomes, patient safety, patient satisfaction, user-friendliness, resource use, goal achievement, and the quality on the information exchange between the different settings of the EMS (for example the quality of documentation). The specific research questions were: 1) are pre-hospital triage systems effective, 2) is one triage system more effective than others, and 3) is it effective to use the same triage system in two or more settings of the EMS-chain? We conducted a systematic literature search in nine databases up to June 2012. We searched for systematic reviews (SRs), randomized controlled trials (RCTs), non-randomized controlled trials (non-RCTs), controlled before and after studies (CBAs) and interrupted time series analyses (ITSs). Two persons independently reviewed titles and abstracts, and the same persons read all possibly relevant full text articles and rated the methodological quality where relevant. The literature search identified 11011 unique references. A total of 120 publications were read in full text. None of the identified articles fulfilled our inclusion criteria, thus our question on the effects of pre-hospital triage systems, if one system is better than other systems, and the question on effects of using the same triage system in two or more settings of the EMS, remain unanswered. We conclude that there is an evidence gap regarding the effects of pre-hospital triage systems and the effects of using the same triage system in two or more settings of the EMS. The finding does not mean that pre-hospital triage systems are ineffective, but that we lack knowledge about potential effects. When introducing a new assessment tool in the EMS, it is timely to conduct well-planned studies aimed to assess the effect.
Highlights
Triage systems are currently used in the emergency medical services (EMS) both in the pre-hospital setting and in hospitals in Scandinavia
The main finding of this systematic review is that there is a lack of scientific documentation evaluating whether or not pre-hospital triage systems are effective, if one triage system is more effective than others, and whether or not it is effective to use the same triage system in two or more settings of an EMS regarding health outcomes, patient safety, patient satisfaction, user-friendliness, resource use, goal achievement, and regarding the quality of the information flow between the different settings of the EMS
From this systematic review, we conclude that there is a lack of scientific evidence about the effects of validated pre-hospital triage systems and about the effects of using the same triage system in two or more settings of the EMS
Summary
Triage systems are currently used in the emergency medical services (EMS) both in the pre-hospital setting and in hospitals in Scandinavia. Triage systems are methods for systematic prioritizing of patients’ treatment according to how urgent they need care. The triage result should influence the order and priority of emergency treatment, the order and priority of emergency transport, or the transport destination for the patient. Triage assessment is usually done in at least one setting of the EMS, and sometimes triage takes. Modern approaches to triage assessment of acutely ill or injured patients are usually based on trace and trigger tools for vital signs, and include a systematic questionnaire for each chief complaint and generally physiological findings. The most common triage systems are those for use in the ED developed during the 1990s and 2000s [1,2].
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