Prehospital Emergency Care
ISSN: 1090-3127 (Print) 1545-0066 (Online) Journal homepage: http://www.tandfonline.com/loi/ipec20
Prehospital Trauma Triage Decision-making: A Model of What Happens between the 9-1-1 Call and the Hospital Courtney Marie Cora Jones PhD, MPH, Jeremy T. Cushman MD, MS, E. Brooke Lerner PhD, Susan G. Fisher PhD, Christopher L. Seplaki PhD, Peter J. Veazie PhD, Erin B. Wasserman BA, Ann Dozier RN, PhD & Manish N. Shah MD, MPH To cite this article: Courtney Marie Cora Jones PhD, MPH, Jeremy T. Cushman MD, MS, E. Brooke Lerner PhD, Susan G. Fisher PhD, Christopher L. Seplaki PhD, Peter J. Veazie PhD, Erin B. Wasserman BA, Ann Dozier RN, PhD & Manish N. Shah MD, MPH (2015): Prehospital Trauma Triage Decision-making: A Model of What Happens between the 9-1-1 Call and the Hospital, Prehospital Emergency Care, DOI: 10.3109/10903127.2015.1025157 To link to this article: http://dx.doi.org/10.3109/10903127.2015.1025157
Published online: 27 May 2015.
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Date: 06 November 2015, At: 03:46
PREHOSPITAL TRAUMA TRIAGE DECISION-MAKING: A MODEL OF WHAT HAPPENS BETWEEN THE 9-1-1 CALL AND THE HOSPITAL Courtney Marie Cora Jones, PhD, MPH, Jeremy T. Cushman, MD, MS, E. Brooke Lerner, PhD, Susan G. Fisher, PhD, Christopher L. Seplaki, PhD, Peter J. Veazie, PhD, Erin B. Wasserman, BA, Ann Dozier, RN, PhD, Manish N. Shah, MD, MPH
Downloaded by [University of Wisconsin Oshkosh] at 03:46 06 November 2015
ABSTRACT
highlighted that trauma triage is complex and there is often limited time to make destination decisions. Four overarching domains were identified within the context of trauma triage decision-making: 1) initial assessment; 2) importance of speed versus accuracy; 3) usability of current field triage criteria; and 4) consideration of patient and emergency care system-level factors. Field triage is a complex decisionmaking process which involves consideration of many patient and system-level factors. The decision model presented in this study suggests that EMS providers place significant emphasis on speed of decisions, relying on initial impressions and immediately observable information, rather than precise measurement of vital signs or systematic application of field triage criteria. Key words: triage, emergency medical services, medical decision-making
We describe the decision-making process used by emergency medical services (EMS) providers in order to understand how 1) injured patients are evaluated in the prehospital setting; 2) field triage criteria are applied in-practice; and 3) selection of a destination hospital is determined. We conducted separate focus groups with advanced and basic life support providers from rural and urban/suburban regions. Four exploratory focus groups were conducted to identify overarching themes and five additional confirmatory focus groups were conducted to verify initial focus group findings and provide additional detail regarding trauma triage decision-making and application of field triage criteria. All focus groups were conducted by a public health researcher with formal training in qualitative research. A standardized question guide was used to facilitate discussion at all focus groups. All focus groups were audio-recorded and transcribed. Responses were coded and categorized into larger domains to describe how EMS providers approach trauma triage and apply the Field Triage Decision Scheme. We conducted 9 focus groups with 50 EMS providers. Participants
PREHOSPITAL EMERGENCY CARE 2015;Early Online:1–9
INTRODUCTION For severely injured patients, trauma centers have been shown to decrease the risk of mortality by 25% and to be cost-effective.1,2 However, to be transported to a trauma center via ambulance, emergency medical services (EMS) providers must make accurate field triage decisions when selecting a receiving facility.3,4 This selection of a destination hospital is referred to as trauma triage. Previous research has shown EMS providers have limited ability to predict clinical outcomes of their patients, such as medical necessity of transport, mortality, or hospital admission.5,6 The Field Triage Decision Scheme (FTDS), developed by the American College of Surgeons Committee on Trauma and the Centers for Disease Control and Prevention, was designed to simplify and facilitate risk stratification and the decision-making process by guiding EMS providers in their selection of a destination hospital.3,7 The goal of the FTDS is to minimize undertriage, defined as transportation of severely injured patients to non-trauma centers, without excessive overtriage.4,7 Both undertriage and overtriage have implications for patient outcomes and efficiency of the overall emergency care system.1,8−10 The accuracy of these prehospital trauma triage guidelines to identify severely injured patients, even when applied consistently and uniformly to all patients, is suboptimal and fails to attain standards set by the American College of Surgeons Committee on Trauma (goal: undertriage