Field Triage Research Articles

Field triage of victims of trauma. Efficacy of trauma team activation protocols

Field triage of victims of trauma. Efficacy of trauma team activation protocols

Patients with severe traumatic brain injury transferred to a Level I or II trauma center

Patients with severe traumatic brain injury (TBI), head Abbreviated Injury Scale (AIS) score of 3 or greater, who are indirectly transported from the scene of injury to a nontrauma center can experience delays to definitive neurosurgical management. Transport to a hospital with appropriate initial emergency department treatment and rapid admission has been shown to reduce mortality in a state's trauma system. This study was conducted to see if the same finding holds with a nationally representative sample of patients with severe TBI seen at Level I and II trauma centers. This study is based on adult (≥18 years), severe TBI patients treated in a nationally representative sample of Level I and II trauma centers, submitting data to the National Trauma Databank National Sample Program from 2007 to 2009. We analyzed independent variables including age, sex, primary payer, race, ethnicity, mode of transport, injury type (blunt vs. penetrating), mechanism of injury, trauma center level, head AIS, initial Glasgow Coma Scale (GCS), Injury Severity Score (ISS), and systolic blood pressure by transfer status. The primary outcome variable was inpatient death, with discharge disposition, neurosurgical procedures, and mean hospital, intensive care unit, and ventilator days serving as secondary outcomes. After exclusion criteria were applied (ISS < 16; age < 18 years; GCS motor score = 6; non-head AIS score ≥ 3; head AIS < 3; patients with missing transfer status, and death on arrival), a weighted sample of 51,300 (16%) patients was eligible for analysis. In bivariate analyses, transferred patients were older (≥60 years), white, insured, less severely injured (head AIS score ≤ 4, ISS ≤ 25), and less likely to have sustained penetrating trauma (p < 0.001). After controlling for all variables, direct transport, 1 or more comorbidities, advanced age, head AIS score, intracranial hemorrhage, and firearm injury remained significant predictors of death. Being transferred (adjusted odds ratio, 0.79; 95% confidence interval, 0.64-0.96) lowered the risk of death. Patients with severe TBI who were transferred to a Level I or II trauma center had lower injury severity, including less penetrating trauma, and, as a result, were less likely to die compared with patients who were directly admitted to a Level I or II trauma center. The results may demonstrate adherence with the current Guidelines for Prehospital Management of Traumatic Brain Injury and Guidelines for Field Triage of Injured Patients, which recommend the direct transport of patients with severe TBI to the highest level trauma center. Patients with severe TBI who cannot be taken to a trauma center should be stabilized at a nontrauma center and then transferred to a Level I or II trauma center. Regional and national trauma databases should consider collecting information on patient outcomes at referral facilities and total transport time after injury, to better address the outcomes of patient triage decisions. Prognostic study, level III; therapeutic study, level IV.

Timely and optimal treatment of patients with STEMI

Fibrinolysis is recommended in European and US guidelines for patients with ST-segment elevation myocardial infarction (STEMI) when a strategy of primary percutaneous coronary intervention (PPCI) is associated with ≥120 min delay from first medical contact (FMC), defined as call to the emergency medical services or self-presentation at hospital. Current evidence indicates that reperfusion therapy should be initiated as soon as possible after FMC. However, fibrinolysis cannot be initiated instantaneously at FMC, and PPCI is superior to fibrinolysis in reducing mortality if the extra time needed to perform PPCI instead of fibrinolysis (so-called PCI-related delay) is <120 min. During the past 10 years, the terms 'FMC-to-PPCI delay' and 'PCI-related delay' have been used in guidelines synonymously; however, a distinction should be made between the recommended FMC-to-PPCI delay and the acceptable PCI-related delay. In the future, an ideal recommendation would be to initiate reperfusion as soon as possible, preferably within 120 min of FMC in the case of PPCI. When the expected PCI-related delay is <120 min, PPCI should be the preferred reperfusion strategy, even if the FMC-to-PPCI delay is >120 min. Setting up a health-care system enabling prehospital diagnosis of STEMI with field triage of patients directly to catheterization laboratories at large-volume PCI centres (bypassing local hospitals, coronary care units, emergency departments, and intensive care units) will help to increase the proportion of patients with STEMI who will benefit from PPCI.

EMS Triage and Transport of Intoxicated Individuals to a Detoxification Facility Instead of an Emergency Department

We evaluate the effectiveness and safety of emergency medical services (EMS) provider use of a checklist to triage alcohol-inebriated patients directly to a detoxification facility, rather than an emergency department (ED). A retrospective cohort study was conducted of all patients evaluated during a 2-year period, from 2003 to 2005, by EMS providers who used a detoxification evaluation checklist to aid in triage decisionmaking. Patients who did not meet detoxification evaluation checklist criteria were transported to an ED. Twelve-hour follow-up was solicited for patients taken to the detoxification center. Hospital records of inebriated patients transported to an ED were reviewed to assess ultimate need for ED care. Seven hundred eighteen patient encounters were reviewed. One hundred thirty-eight of these patients (19.2%) were transported to the detoxification facility, whereas 580 (80.8%) were transported to an ED; 339 patients transported to an ED were ultimately deemed to have required ED care. The criteria that most commonly excluded transport to the detoxification center were an inability to ambulate with minimal assistance (N=334) and an unwillingness to cooperate with the physical examination (N=195). Low-acuity adverse events were observed in 4 subjects (0.6%) initially transported to the detoxification center who then required subsequent transport to an ED. No high-acuity clinical complications were identified at any time. The use of the detoxification evaluation checklist resulted in high sensitivity (99%; 95% confidence interval 97% to 100%) and low specificity (42%; 95% confidence interval 37% to 48%) in predicting need for ED care. Our analysis suggests that field triage criteria can be used effectively to safely divert inebriated patients to a detoxification facility rather than an ED, with minimal adverse events. Use of the detoxification evaluation checklist resulted in substantial ED overtriage, and further refinement of the detoxification evaluation checklist criteria is needed to reduce it.

Thrombolysis in myocardial infarction (TIMI) risk score remains relevant in the era of field triage of patients with ST elevation myocardial infarction treated with primary percutaneous coronary intervention

Thrombolysis in myocardial infarction (TIMI) risk score remains relevant in the era of field triage of patients with ST elevation myocardial infarction treated with primary percutaneous coronary intervention

Triage During Mass Gatherings

Triage is a complex process and is one means for determining which patients most need access to limited resources. Triage has been studied extensively, particularly in relation to triage in overcrowded emergency departments, where individuals presenting for treatment often are competing for the available stretchers. Research also has been done in relation to the use of prehospital and field triage during mass-casualty incidents and disasters. In contrast, scant research has been done to develop and test an effective triage approach for use in mass-gathering and mass-participation events, although there is a growing body of knowledge regarding the health needs of persons attending large events. Existing triage and acuity scoring systems are suboptimal for this unique population, as these events can involve high patient presentation rates (PPR) and, occasionally, critically ill patients. Mass-gathering events are dangerous; a higher incidence of injury occurs than would be expected from general population statistics. The need for an effective triage and acuity scoring system for use during mass gatherings is clear, as these events not only create multiple patient encounters, but also have the potential to become mass-casualty incidents. Furthermore, triage during a large-scale disaster or mass-casualty incident requires that multiple, local agencies work together, necessitating a common language for triage and acuity scoring. In reviewing existing literature with regard to triage systems that might be employed for this population, it is noted that existing systems are biased toward traumatic injuries, usually ignoring mitigating factors such as alcohol and drug use and environmental exposures. Moreover, there is a substantial amount of over-triage that occurs with existing prehospital triage systems, which may lead to misallocation of limited resources. This manuscript presents a review of the available literature and proposes a triage system for use during mass gatherings that also may be used in the setting of mass-casualty incidents or disaster responses.

Symptom onset-to-balloon time and mortality in the first seven years after STEMI treated with primary percutaneous coronary intervention

ObjectiveTo evaluate the consequence of treatment delay of primary percutaneous coronary intervention (PPCI) on long-term survival.BackgroundNetwork organisation based on early recognition, shortening prehospital time delays and procedural delays is the...

Reperfusion delay in patients treated with primary percutaneous coronary intervention: insight from a real world Danish ST-segment elevation myocardial infarction population in the era of telemedicine

Reperfusion delay in ST-segment elevation myocardial infarction (STEMI) predicts adverse outcome. We evaluated time from alarm call (system delay) and time from first medical contact (PCI-related delay), where fibrinolysis could be initiated, to balloon inflation in a pre-hospital organization with tele-transmitted electrocardiograms, field triage and direct transfer to a 24/7 primary percutaneous coronary intervention (PPCI) center. This was a single center cohort study with long-term follow-up in 472 patients. The PPCI center registry was linked by person identification number to emergency medical services (EMS) and National Board of Health databases in the period of 2005-2008. Patients were stratified according to transfer distances to PPCI into zone 1 (0-25 km), zone 2 (65-100 km) and zone 3 (101-185 km) and according to referral by pre-hospital triage. System delay was 86 minutes (interquartile range (IQR) 72-113) in zone 1, 133 (116-180) in zone 2 and 173 (145-215) in zone 3 (p<0.001). PCI-related delay in directly referred patients was 109 (92-121) minutes in zone 2, but exceeded recommendations in zone 3 (139 (121-160)) and for patients admitted via the local hospital (219 (171-250)). System delay was an independent predictor of mortality (p<0.001). Pre-hospital triage is feasible in 73% of patients. PCI-related delay exceeded European Society of Cardiology (ESC) guidelines for patients living >100 km away and for non-directly referred patients. Sorting the PPCI centers catchment area into geographical zones identifies patients with long reperfusion delays. Possible solutions are pharmaco-invasive regiments, research in early ischemia detection, airborne transfer and EMS personnel education that ensures pre-hospital triage.

Evaluation of Field Triage Decision Scheme Educational Resources

In an effort to encourage appropriate field triage procedures, the Centers for Disease Control and Prevention (CDC), in collaboration with the National Highway Traffic Safety Administration and the American College of Surgeons-Committee on Trauma, convened the National Expert Panel on Field Triage to update the Field Triage Decision Scheme: The National Trauma Triage Protocol (Decision Scheme). In support of the Decision Scheme, CDC developed educational resources for emergency medical service (EMS) professionals, one of CDC's first efforts to develop and broadly disseminate educational information for the EMS community. CDC wanted to systematically collect information from the EMS community on what worked and what did not with respect to these educational materials and which materials were of most use. An evaluation was conducted to obtain feedback from EMS professionals about the Decision Scheme and use of Decision Scheme educational materials. The evaluation included a survey and a series of focus groups. Findings indicate that a segment of the Decision Scheme's intended audience is using the materials and learning from them, and they have had a positive influence on their triage practices. However, many of the individuals who participated in this research are not using the Decision Scheme and indicated that the materials have not affected their triage practices. Findings presented in this article can be used to inform development and distribution of additional Decision Scheme educational resources to ensure they reach a greater proportion of EMS professionals and to inform other education and dissemination efforts with the EMS community.

Service provision in disaster preparation, response, and recovery for individuals with predisaster mental illness

Individuals with preexisting mental disorders are at increased risk for negative outcomes following a disaster and are one type of vulnerable subpopulation that requires special consideration in disaster preparedness, response, and recovery. We describe evidence of the increased risk for individuals with predisaster mental illness as well as tools for field triage, the critical role of partnerships in preparedness and response, and integration of mental health as a priority in emergency management systems. Considering individuals with predisaster mental disorders at each phase of a disaster may ameliorate some negative postdisaster outcomes, such as suicide.

Inappropriate Helicopter Emergency Medical Services Transports: Results of a National Cohort Utilization Review

Background. Medical transport using helicopter emergency medical services (HEMS) has rapidly proliferated over the past decade. Because of issues of cost and safety, appropriate utilization is of increasing concern. Objective. This study sought to describe the medical appropriateness of HEMS transports, using established guidelines, in a large national patient cohort. Methods. A review was performed of all flights designated as inappropriate by a large national air medical company, Air Evac EMS Inc. (which operates Air Evac Lifeteam [AEL]), for the period from January 1, 2009, through December 31, 2009. Every flight was reviewed initially through a resource utilization process as well as a utilization review process. Medical appropriateness review criteria were derived from the Medicare Benefit Policy Manual and industry guidelines outlined by the Commission on Accreditation of Medical Transport Systems (CAMTS), Air Medical Physicians Association (AMPA) position papers, the Centers for Disease Control and Prevention (CDC) Morbidity and Mortality Weekly Report (MMWR) Guidelines for Field Triage, and published clinical peer-reviewed articles, as well as previous interactions with Medicare contractors and reimbursement appeal decisions. Higher scrutiny was given to flights of <30 or >100 miles. Records indicating a possible inappropriate flight (i.e., review criteria were not satisfied, but special circumstances existed) were further reviewed by a senior quality assurance/quality improvement (QA/QI) nurse and/or senior medical director and were categorized. Results. During the study period, 27,697 flights were completed and reviewed, with 582 (2.1%) flights identified for further review by a senior QA/QI nurse and/or senior medical director. Of those, 367 (1.3%) were determined to be medically inappropriate flights. Inappropriate flights were most often on-scene flights (59.9%), were most often for adult patients (92.9%; median age 56.9 years; 25–75% interquartile range 42–75 years), and most often represented medical diagnoses (57.8%). Conclusions. Based on established criteria, only 1.3% of total flights were determined to be inappropriate. This large national cohort demonstrated compliance with current industry standards.

Disaster triage: Evidence, consistency and standard practice

Triage has military origins, with the initial purpose being to direct care to those most likely to be able to return to the battlefield. Conversely, modern disaster triage attempts to ensure both the prioritisation of care for those who need it most and a fair distribution of resources, so that health responders are able to ‘do the most for the most’...

Evaluating Age in the Field Triage of Injured Persons

We evaluate trauma undertriage by age group, the association between age and serious injury after accounting for other field triage criteria and confounders, and the potential effect of a mandatory age triage criterion for field triage. This was a retrospective cohort study of injured children and adults transported by 48 emergency medical services (EMS) agencies to 105 hospitals in 6 regions of the western United States from 2006 through 2008. We used probabilistic linkage to match EMS records to hospital records, including trauma registries, state discharge databases, and emergency department databases. The primary outcome measure was serious injury, as measured by an Injury Severity Score greater than or equal to 16. We assessed undertriage (Injury Severity Score ≥16 and triage-negative or transport to a nontrauma center) by age decile and used multivariable logistic regression models to estimate the association (linear and nonlinear) between age and Injury Severity Score greater than or equal to 16, adjusted for important confounders. We also evaluated the potential influence of age on triage efficiency and trauma center volume. Injured patients (260,027) were evaluated and transported by EMS during the 3-year study period. Undertriage increased for patients older than 60 years, reaching approximately 60% for those older than 90 years. There was a strong nonlinear association between age and Injury Severity Score greater than or equal to 16. For patients not meeting other triage criteria, the probability of serious injury was most notable after 60 years. A mandatory age triage criterion would have decreased undertriage at the expense of overtriage, with 1 patient with Injury Severity Score greater than or equal to 16 identified for every 60 to 65 additional patients transported to major trauma centers. Trauma undertriage increases in patients older than 60 years. Although the probability of serious injury increases among triage-negative patients with increasing age, the use of a mandatory age triage criterion appears inefficient for improving field triage.

Compliance with Centers for Disease Control and Prevention Field Triage Guidelines in an Established Trauma System

Regionalization of trauma care reduces mortality and has clear guidelines for transport to the highest level of trauma care. Whether prehospital providers follow the CDC triage algorithm remains to be determined. We performed a 5-year retrospective cohort analysis of linked data from Washington State's Central Region Trauma Registry (CRTR) and King County Emergency Medical Services (KCEMS). Patients were analyzed based on transport to their designated hospital, as determined by geocode mapping, or directly to the level I center (no level II center is available in this region). Of the 12,106 patients in the study, 5,976 (49.4%) were transported directly to a level I center from the scene. Of the remaining 6,130 patients initially transported to level III to V centers, 5,024 (41.5%) remained in the respective level III to V centers and 1,106 (9.1%) were transferred to the level I center. Patients transported directly to a level I center were more likely to be male, younger, have a penetrating injury, lower scene Glasgow Coma Scale (GCS), lower scene blood pressure, and be more severely injured. Level I direct scene transport was significantly less likely for older patients. Compared with patients ages 18 to 45, the adjusted odds ratio for direct transport to the level I center was 0.7 (95% CI 0.59 to 0.83) for patients aged 46 to 55 years; 0.47 (95% CI 0.39 to 0.57) for those 56 to 65 years; 0.28 (95% CI 0.23 to 0.34) for patients 66 to 80 years; and 0.11 (95% CI 0.09 to 0.14) for those older than 81 years. Prehospital providers follow physiologic, anatomic, and mechanistic parameters in steps 1 to 3 of the CDC field triage guidelines. However, contrary to the special considerations guideline in step 4, older age was associated with transport to the lower level of trauma care in our region.

Deciphering the use and predictive value of "emergency medical services provider judgment" in out-of-hospital trauma triage: a multisite, mixed methods assessment.

"Emergency medical services (EMS) provider judgment" was recently added as a field triage criterion to the national guidelines, yet its predictive value and real world application remain unclear. We examine the use and independent predictive value of EMS provider judgment in identifying seriously injured persons. We analyzed a population-based retrospective cohort, supplemented by qualitative analysis, of injured children and adults evaluated and transported by 47 EMS agencies to 94 hospitals in five regions across the Western United States from 2006 to 2008. We used logistic regression models to evaluate the independent predictive value of EMS provider judgment for Injury Severity Score ≥ 16. EMS narratives were analyzed using qualitative methods to assess and compare common themes for each step in the triage algorithm, plus EMS provider judgment. 213,869 injured patients were evaluated and transported by EMS over the 3-year period, of whom 41,191 (19.3%) met at least one of the field triage criteria. EMS provider judgment was the most commonly used triage criterion (40.0% of all triage-positive patients; sole criterion in 21.4%). After accounting for other triage criteria and confounders, the adjusted odds ratio of Injury Severity Score ≥ 16 for EMS provider judgment was 1.23 (95% confidence interval, 1.03-1.47), although there was variability in predictive value across sites. Patients meeting EMS provider judgment had concerning clinical presentations qualitatively similar to those meeting mechanistic and other special considerations criteria. Among this multisite cohort of trauma patients, EMS provider judgment was the most commonly used field trauma triage criterion, independently associated with serious injury, and useful in identifying high-risk patients missed by other criteria. However, there was variability in predictive value between sites.

A Review of Traumatic Brain Injury Trauma Center Visits Meeting Physiologic Criteria from the American College of Surgeons Committee on Trauma/Centers for Disease Control and Prevention Field Triage Guidelines

Background. Traumatic brain injury (TBI) represents a serious subset of injuries among persons in the United States, and prehospital care of these injuries can mitigate both the morbidity and the mortality in patients who suffer from these injuries. Guidelines for triage of injured patients have been set forth by the American College of Surgeons Committee on Trauma (ACS-COT) in cooperation with the Centers for Disease Control and Prevention (CDC). These guidelines include physiologic criteria, such as the Glasgow Coma Scale (GCS) score, systolic blood pressure, and respiratory rate, which should be used in determining triage of an injured patient. Objectives. This study examined the numbers of visits at level I and II trauma centers by patients with a diagnosed TBI to determine the prevalence of those meeting physiologic criteria from the ACS-COT/CDC guidelines and to determine the extent of mortality among this patient population. Methods. The data for this study were taken from the 2007 National Trauma Data Bank (NTDB) National Sample Program (NSP). This data set is a nationally representative sample of visits to level I and II trauma centers across the United States and is funded by the American College of Surgeons. Estimates of demographic characteristics, physiologic measures, and death were made for this study population using both chi-square analyses and adjusted logistic regression modeling. Results. The analyses demonstrated that although many people who sustain a TBI and were taken to a level I or II trauma center did not meet the physiologic criteria, those who did meet the physiologic criteria had significantly higher odds of death than those who did not meet the criteria. After controlling for age, gender, race, Injury Severity Score (ISS), and length of stay in the hospital, persons who had a GCS score ≤13 were 17 times more likely to die than TBI patients who had a higher GCS score (odds ratio [OR] 17.4; 95% confidence interval [CI] 10.7–28.3). Other physiologic criteria also demonstrated significant odds of death. Conclusions. These findings support the validity of the ACS-COT/CDC physiologic criteria in this population and stress the importance of prehospital triage of patients with TBI in the hopes of reducing both the morbidity and the mortality resulting from this injury.

Guidelines for Field Triage of Injured Patients

Guidelines for Field Triage of Injured Patients

A model for rural trauma care

In the United States and many other countries, there has been limited attempt to develop a trauma system that addresses the unique trauma situations that occur in rural areas. Rather the planners have attempted to simply extend the urban based trauma system into rural communities. This extension does not address the needs of the majority of patients who are injured in rural communities. A review of the types of patients seen in the rural communities, the volume of these patients and the destination protocols used in the rural communities as taught by the ACS/ATLS and the implications of the CDC Guidelines for Field Triage of Injured Patients Recommendations of the National Expert Panel on Field Triage were reviewed, assessed and compared to the needs in the rural areas for a rural trauma system. In addition, a quality assessment tool was used from a major trauma centre whereby the frequency of patients transported to the centre that were inappropriate for the trauma centre was indicated by the volume that were discharged in 6 h. Most of the patients injured in the rural communities can be treated in the critical access and rural hospital (> 90 per cent) and can be provided with good care without the need for emergency medical service (EMS) transportation long distances to the trauma centre, inappropriate use of air EMS vehicles thus circumventing families having to travel long distances to see patients, incurring expense and inconvenience, and avoiding loss of revenue to the local hospitals and the overload of urban trauma centres. Rather triage criteria can be taught as per the EMS systems, training given to rural hospital personnel, hospital administrators instructed as to the benefit of such a system, citizens educated as to the advantage of keeping their loved ones closer to home and trauma system registries used to enhance the correct use of the trauma system. Only 5-10 per cent of trauma injuries require the resources of a trauma centre. Proper triage and medical provider education can be used for the benefit of the patient, the EMS system, the rural and urban hospital, and proper quality assurance to assure that the 'right patient is treated at the right hospital at the right time', for the benefit of the patient.

The Tyranny of Distance: Emergency Regional Transfers for STEMI

Aim: We aimed to characterise regional center emergency catheterisation referrals for ST elevationmyocardial infarction (STEMI) or cardiac arrest (CA). Methods: A single institution prospective database of STEMI/CA patients was interrogated to identify these patients and descriptive statistics derived. Findings: Sixty-five (65) patients were identified (2008 to February 2012). The following baseline characteristics were present: age 60± 13 years (mean± standard deviation), 82% male, 66% post-fibrinolysis, 7% CA, and 15% shocked. Percutaneous intervention (PCI) was performed in 89% (success 98%). Balloonpumpswereused in 9%.Two patients received urgent bypass surgery. One patient had the final diagnosis not STEMI. The hospital mortality was: 7.7%. The median distance from the institution of referring site was 138 (72,240) km with range 6–597 km. A map is shown below (point size scaled to referral number). The average time from onset of symptoms to cath lab arrival (CLA) was 5.8 h. This time was correlated with distance (p< 0.05). It explained only 19% of the variation. The day of week and time of day of CLA are shown in the second viously been assessed in the era of primary percutaneous coronary intervention (PCI). We sought to determine the validity of the TRS in both male and female ST Elevation Myocardial Infarction (STEMI) patients who have undergone early field triage. Methods: This was a single centre retrospective cohort study identifying consecutive STEMI patients presenting for primary-PCI via field triage between May 2004 and December 2010. Unpaired t-tests were used to determine significant demographic differences in males and females. Linear regression analysis was used to determine the correlation of the TRS with the endpoints of 30 day majoradverse cardiacevents (MACE)andmedianhospital length of stay (LOS). Results: 329 patients presented with STEMI via field triage, of which 248 (75.4%)weremale and 81 (24.6%)were female. Women were more likely to be older (73.2 vs 68.2, p< 0.0001), hypertensive (60.5% vs 44.9%, p< 0.05), show signsofpulmonaryoedemaatpresentation (17.5%vs7.6%, p< 0.05) andhaveahigherTRS (4.90 vs 3.14,p< 0.0001). The TRS was predictive of MACE (R2 = 0.57, p< 0.02) and hospital LOS (R2 = 0.79, p< 0.001) in the entire cohort. The TRS was found to be predictive of MACE and hospital LOS in males (R2 = 0.57, p< 0.02; R2 = 0.87, p< 0.0001 respectively) as well as females (R2 = 0.58, p< 0.02; R2 = 0.66, p< 0.02 respectively). Conclusion: The TRS is a useful prognostic tool in

Transcatheter Aortic Valve Implantation in Patients with Severe Aortic Stenosis—12 Month Outcome Data from a Single Victorian Centre

Methods: This was a single centre retrospective cohort study identifying consecutive STEMI patients presenting for primary-PCI via field triage between May 2004 and December 2010. Linear regression analysis was used to determine the correlation of the TRS with 30 day major adverse cardiac events (MACE) and median hospital length of stay (LOS). Regression analysis was also used todetermine applicability indiffering ischaemic times and ages. Results: 329 patients were identified. The TRS strongly correlated with MACE (R2 = 0.57, p 120min, the TRS correlated with LOS but not MACE (R2 = 0.76, p 75 (R2 = 0.57, p 75 (p= 0.90). Conclusion: The TRS remains a useful prognostic tool in STEMI patients undergoing early field triage, particularly in shorter ischaemic times and younger patients. It appears to be less robust in elderly patients. The TRS is also a useful predictor of length of hospital stay and may be beneficial in management of hospital logistics.