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. 2020 Feb;46(1):131-146.
doi: 10.1007/s00068-018-1006-8. Epub 2018 Sep 20.

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

Eveline A J van Rein  1 , Said Sadiqi  2 , Koen W W Lansink  3 , Rob A Lichtveld  4 , Risco van Vliet  5 , F Cumhur Oner  2 , Luke P H Leenen  6 , Mark van Heijl  6   7
Affiliations

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

Eveline A J van Rein et al. Eur J Trauma Emerg Surg. 2020 Feb.

Abstract

Purpose: Severely 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.

Methods: All 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.

Results: For 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.

Conclusion: The 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.

Keywords: Adherence; Compliance; Prehospital; Trauma; Triage.

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Conflict of interest statement

Authors E. A. J. van Rein, S. Sadiqi, K. W. W. Lansink, R. A. Lichtveld, R. van Vliet, F. C. Oner, L. P. H. Leenen and M. van Heijl declare no conflict of interest.

Figures

Fig. 1
Fig. 1
The national field triage protocol of the Netherlands
Fig. 2
Fig. 2
Factors influencing the destination decision for adult and paediatric patients
Fig. 3
Fig. 3
Factors of influence on undertriage and factors lowering undertriage
Fig. 4
Fig. 4
Factors of influence on overtriage and factors lowering overtriage
See this image and copyright information in PMC

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