Introduction:With the introduction of regional trauma networks in England, ambulance clinicians have been required to make triage decisions relating to severity of injury, and appropriate destination for the patient, which may require 'bypassing' the nearest Emergency Department. A 'Trauma Unit Bypass Tool' is utilised in this process. The Major Trauma Triage tool smartphone application (App) is a digital representation of a tool, available for clinicians to use on their smartphone. Prior to disseminating the application, validity and performance against the existing paper-based tool was explored. Methods: A case-based study using clinical scenarios was conducted. Scenarios, with appropriate triage decisions, were agreed by an expert panel. Ambulance clinicians were assigned to either the paperbased tool or smartphone app group and asked to make a triage decision using the available information. The positive predictive value (PPV) of each tool was calculated. Results: The PPV of the paper tool was 0.76 and 0.86 for the smartphone app. User comments were mainly positive for both tools with no negative comments relating to the smartphone app. Conclusion:The smartphone app version of the Trauma Unit Bypass Tool performs at least as well as the paper version and can be utilised safely by pre-hospital clinicians in supporting triage decisions relating to potential major trauma.

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The provision of an onsite, 24 h helipad facility at UHS has resulted in a significant number of patients being transported to the hospital by helicopter who might otherwise have attended an alternative hospital.

Aims, Objectives and BackgroundIn order to direct patients to specialist Major Trauma Centres (MTCs), triage is performed at the scene of an incident to evaluate the extent of a patient’s injuries. The most severely injured patients are then transported directly to an MTC, even if there is a closer ED. This process is known as ‘Trauma Unit Bypass’ (TUB) and decision support tools are provided for use by ambulance service providers. This study aims to evaluate a tool in current operational use and suggest amendments which may improve its performance in clinical practice.Method and DesignData from a period of 12-months (1065 cases) were used to evaluate the performance of a TUB tool used in an English ambulance service. Data were sourced from the Trauma Audit and Research Network (TARN) and ED records and case reviews were performed to extract the required information. Statistical analysis was performed to evaluate the accuracy of the tool in identifying major trauma, defined as an Injury Severity Score (ISS) greater than 15. Further analysis was undertaken to make recommendations for alterations to the toolResults and ConclusionThe sensitivity of the Wessex TUB is 51.3% and the specificity is 71.3% which makes the tool a poor predictor of major trauma. The tool could be improved by altering thresholds for vital signs (blood pressure and Glasgow Coma Scale) and by providing clarity around the injury findings.This study provides the first full evaluation of this tool in clinical practice and makes some recommendations to improve performance. This could lead to more accurate identification of patients who have suffered major trauma and ensure they are transported to an appropriate specialist centre. However, it was identified that ISS>15 may not be the most useful outcome measure and it is recommended that a new definition is developed which more accurately describes need for MTC input.