The national trauma triage protocol: how EMS perspective can inform the guideline revision. Issue 1 (18th January 2022)

• Record Type: Journal Article
• Authors: Fischer, Peter E; Gestring, Mark L; Sagraves, Scott G; Michaels, Holly N; Patel, Bhavin; Dodd, Jimm; Campion, Eric M; VanderKolk, Wayne E; Bulger, Eileen M
• Is Part Of: Trauma surgery & acute care open. Volume 7:Issue 1(2022)
• Publication Date: 2022-01-18
• Subjects: EMS -- triage -- emergency medical services -- multiple trauma; Traumatology -- Periodicals; Critical care medicine -- Periodicals; Wounds and injuries -- Periodicals; 617.1
• DOI: 10.1136/tsaco-2021-000879
• Languages: English
• ISSNs: 2397-5776

Abstract

Abstract : Objectives: The Field Triage Guidelines (FTG) support emergency medical service (EMS) decisions regarding the most appropriate transport destination for injured patients. While the components of the algorithm are largely evidenced-based, the stepwise approach was developed with limited input from EMS providers. FTG are only useful if they can easily be applied by the field practitioner. We sought to gather end-user input on the current guidelines from a broad group of EMS stakeholders to inform the next revision of the FTG. Methods: An expert panel composed an end-user feedback tool. Data collected included: demographics, EMS agency type, geographic area of respondents, use of the current FTG, perceived utility, and importance of each step in the algorithm (1: physiologic, 2: anatomic, 3 mechanistic, 4: special populations). The American College of Surgeons Committee on Trauma (ACS COT), in partnership with several key organizations, distributed the tool to reach as many providers as possible. Results: 3958 responses were received (82% paramedics/emergency medical technicians, 9% physicians, 9% other). 94% responded directly to scene emergency calls and 4% were aeromedical providers. Steps 2 and 3 were used in 95% of local protocols, steps 1 and 4 in 90%. Step 3 was used equally in protocols across all demographics; however, step 1 was used significantly more in the air medical services than ground EMS (96% vs 88%, p<0.05). Geographic variation was demonstrated in FTG use based on the distance to a trauma center, but step 3 (not step 1) drove the majority of the decisions. This point was reinforced in the qualitative data with the comment, "I see the wreck before I see the patient." Conclusion: The FTG are widely used by EMS in the USA. The stepwise approach is useful; however, mechanism (not physiological criteria) drives most of the decisions and is evaluated first . Revision of the FTG should consider the experience of the end-users. Level of evidence: V.