Prehospital Prediction of the Severity of Blunt Anatomic Injury

Abstract

Paramedics were unable to reliably identify severe injury to individual body regions. Sensitivity of paramedic judgment of major trauma status was high. Assessment of the severity of injury to individual body regions did not appear to improve accuracy.

An Evidence-based Guideline for the Air Medical Transportation of Prehospital Trauma Patients

“…Two prospective observational studies demonstrated that paramedics can apply standing orders for a variety of medical and trauma-related complaints with acceptably low error rates and few adverse outcomes. 41,42 Mulholland et al demonstrated that paramedics could independently and reliably identify patients with life-threatening injuries, lessening the concern for undertriage for the critically ill. 35 A retrospective review of triage appropriateness by Lubin et al concluded that paramedics and community emergency physicians have similar proficiency at identifying cases appropriate for transfer to a level I trauma center. 43 However, a prospective observational study by Champion et al suggested paramedics might have a tendency to overtriage, and that online medical direction (OLMD) might reduce the overtriage rates by up to 50% in low-severity cases.…”

“…10,11 One recent analysis determined that the costs associated with trauma care and overtriage would decrease substantially if the CDC Guidelines for the Field Triage of Injured Patients were consistently applied.…”

“…11,[19][20][21][22][23][24][25][26][27] This EBG builds off the CDC criteria as a starting point in the triage process, then elaborates on the circumstances in which ground and air medical transport might best be used. The decision-making surrounding transport modality is inextricably linked to the data informing trauma triage, since patients at higher risk of injury are more time-sensitive cases for which advanced intervention and transport to highlevel trauma care is often achievable only via HEMS.…”

“…32,33 The same concerns apply to triage decisions based solely on anatomic or situational factors. 31,34,35 The strength of evidence addressing patient morbidity and mortality associated with field triage decisions was judged to be low, largely due to the lack of prospective, large-scale trials. The prospective data that do exist are derivation studies or pilottesting of new triage parameters, such as heart-rate variability.…”

“…Future research is required to strengthen the data and recommendations, define optimal approaches for guideline implementation, and determine the impact of implementation on safety and outcomes including cost. Key words: Air ambulances; ambulances; emergency medical services; evidence-based emergency medicine; practice guidelines; trauma; triage PREHOSPITAL EMERGENCY CARE 2014;18(Suppl 1): [35][36][37][38][39][40][41][42][43][44] …”