The care of CRC patients in the setting of an acute severe illness typically requires the joint efforts of the emergency medical team in consultation with surgical, medical, and radiation oncology. A high degree of suspicion for the typical and atypical complications of CRC is important for all clinicians who are responsible for the care of these patients.

Background The Field Triage Decision Scheme is a national guideline that has been implemented widely for prehospital Emergency Medical Services (EMS) and trauma systems. However, little is known about the uptake, modification or variation in field application of triage criteria between trauma systems. Objective To describe and compare the use of field triage criteria by EMS personnel in 6 regions, including the timing of guideline uptake and use of non-guideline criteria. Methods This was a retrospective cohort study of injured children and adults transported by 48 EMS agencies to 105 hospitals (trauma and non-trauma centers) in 6 Western U.S. regions from 2006 through 2008. We used probabilistic linkage to match patient-level prehospital information from multiple sources, including: EMS records, base-hospital phone communication records and trauma registry data files. Triage criteria were evaluated individually and grouped by “steps” (physiologic, anatomic, mechanism and special considerations). We used descriptive statistics to compare the frequency of triage criteria use (overall and between regions) and to evaluate the timing of guideline uptake across multiple versions of the guidelines. Results A total of 260,027 injured patients were evaluated and transported by EMS over the 3-year study period, of whom 46,414 (18%) met at least one field triage criterion and formed the primary sample for analysis. The 3 most common criteria cited (of 33 in use) were: EMS provider judgment (26%), age < 5 or > 55 years (10%) and GCS score <14 (9%). Of the 33 criteria in use, 5 (15%) were previously retired from the guidelines and 7 (21%) were never included in the guidelines. 11,048 (24%) of patients had more than 1 criteria applied (range 1 – 21). There was large variation in the type and frequency of criteria used between systems, particularly among the non-physiologic triage steps. Only 1 of 6 regions had translated the most recent guidelines into field use within 2 years of release. Conclusion There is large variation between regions in the frequency and type of field triage criteria used. Field uptake of guideline revisions appears slow and variable, suggesting opportunities for improvement in dissemination and implementation of updated guidelines.