Deciphering the use and predictive value of “emergency medical services provider judgment” in out-of-hospital trauma triage

Newgard, Craig D.; Kampp, Michael; Nelson, Maria J.; Holmes, James F.; Zive, Dana; Rea, Thomas D.; Bulger, Eileen M.; Liao, Michael M.; Sherck, John P.; Hsia, Renee Y.; Wang, N. Ewen; Fleischman, Ross J.; Barton, Erik D.; Daya, Mohamud; Heineman, John T.; Kuppermann, Nathan

doi:10.1097/ta.0b013e3182468b51

Cited by 40 publications

(54 citation statements)

References 28 publications

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“…Emergency Medical Services provider judgment has been shown to be predictive of serious injury, even after accounting for other triage criteria. 38 Selective application of the guidelines, patient choice, EMS provider knowledge and training, provider beliefs, availability of EMS units, traffic, weather, and hospital proximity can also contribute to triage decision making.…”

Section: Discussionmentioning

confidence: 99%

Prospective Validation of the National Field Triage Guidelines for Identifying Seriously Injured Persons

Newgard

Zive

et al. 2016

Journal of the American College of Surgeons

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Section: Discussionmentioning

confidence: 99%

Prospective Validation of the National Field Triage Guidelines for Identifying Seriously Injured Persons

Newgard

Zive

et al. 2016

Journal of the American College of Surgeons

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100

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“…23 Another study also found that EMS provider judgment was frequently cited as a criterion for transport and was associated with a 23% increased odds of having a severe injury. 24 However, a literature review concluded that the evidence-base to support paramedic judgment as an accurate triage criterion is lacking. 25 Our model indicates that EMS providers routinely rely on their intuition to make destination decisions, but it is uncertain whether such judgment may have additional value independent of the FTDS.…”

Section: Discussionmentioning

confidence: 99%

Prehospital Trauma Triage Decision-making: A Model of What Happens between the 9-1-1 Call and the Hospital

Jones¹,

Cushman²,

Lerner³

et al. 2015

Prehospital Emergency Care

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Objective 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. Methods 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. Results We conducted 9 focus groups with 50 EMS providers. Participants 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. Conclusions Field triage is a complex decision-making 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.

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“…“EMS provider judgment” was the most common triage criterion cited by EMS personnel across all regions, being used almost three times as often as the next most commonly cited criterion, even though one region (region A) did not use the criterion at all. The use and independent predictive value of EMS provider judgment in identifying patients with serious injuries 24 and the integral role of provider judgment in out-of-hospital cognitive processing for field triage 25 have been previously detailed. Closer evaluation of the one region not using the EMS provider judgment criterion revealed that the same region had disproportionate use of the “energy” criterion.…”

Section: Discussionmentioning

confidence: 99%

Variation in Prehospital Use and Uptake of the National Field Triage Decision Scheme

Barnett

Wang

Sahni

et al. 2013

Prehospital Emergency Care

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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.

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Deciphering the use and predictive value of “emergency medical services provider judgment” in out-of-hospital trauma triage

Cited by 40 publications

References 28 publications

Prospective Validation of the National Field Triage Guidelines for Identifying Seriously Injured Persons

Prospective Validation of the National Field Triage Guidelines for Identifying Seriously Injured Persons

Prehospital Trauma Triage Decision-making: A Model of What Happens between the 9-1-1 Call and the Hospital

Variation in Prehospital Use and Uptake of the National Field Triage Decision Scheme

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