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Prehospital Trauma Triage Decision-Making: A Model of What Happens Between the 911 Call and the Hospital
Filetype[PDF - 528.07 KB]


Details:
  • Pubmed ID:
    26017368
  • Pubmed Central ID:
    PMC5125413
  • Funding:
    UL1 RR024160/RR/NCRR NIH HHS/United States
    U01 CE002175/CE/NCIPC CDC HHS/United States
  • Document Type:
  • Collection(s):
  • Description:
    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.