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Evaluation of the Triage by Emergency Medical Technicians by Using Trauma Score for Occupant Injuries Caused by Motor Vehicle Collisions  

Kim, Sang Chul (Department of Emergency Medicine, School of Medicine, Konkuk University Chungju Hospital)
Kim, Byung Woo (Department of Paramedic science, Korea National University of Transportation)
Tak, Yang Ju (Department of Paramedic science, Korea National University of Transportation)
Lee, Sang Hee (Department of Paramedic science, Korea National University of Transportation)
Publication Information
Journal of Trauma and Injury / v.26, no.3, 2013 , pp. 89-98 More about this Journal
Abstract
Purpose: The assessment of trauma patients in the prehospital setting is difficult, but appropriate field triage is critical to the prognosis of trauma patients. We sought to evaluate the triage given by the emergency medical technicians (EMTs) using the trauma score to patients injured in motor vehicle collisions (MVCs). Methods: From June 2012 to July 2012, questionnaires were distributed to EMTs, who had transported injured patients to the study hospital. Scene records, photos of the damaged vehicle, and ambulance run sheets were used to provide physiologic, physical, and mechanistic information about the MVC. To evaluate the appropriateness of the injury assessment by EMTs, we compared their impressions with the hospital's final diagnosis within a 3 level triage system comprising both the maximum abbreviated injury scale (MAIS) and the injury severity score (ISS). Kappa (k) was calculated to evaluate the agreement between the triage by EMTs and the triage based on hospital's final diagnosis. Results: A total of 91 patients were analyzed by 31 EMTs. The percentage of males was 57.1%, the mean age was 44.5, and the mean MAIS and ISS were 2.7 and 16.6 respectively. While EMTs correctly diagnosed patient injuries to the extremities in 35.7%, and to the neck in 32.1%, pelvic injuries were missed in 80.0%. The agreement between the triage by the EMTs and the triage based on the hospital's final diagnosis was 62.6%(k=0.366) by the MAIS and 50.5%(k=0.234) by the ISS. The kappa value was higher in EMT-I than in EMT-II. Conclusion: In MVC, the assessment of injured patients by EMT-I was more appropriate, and the 3-level triage method based on the MAIS could contribute to a more accurate triage. Prospective studies to search for appropriate methods of field triage are required for programming practical education for EMTs.
Keywords
Triage; Emergency medical technicians; Emergency medical services; Injury severity score; Abbreviated injury scale;
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1 Travers DA, Waller AE, Bowling JM, Flowers D, Tintinalli J. Five-level triage system more effective than three-level in tertiary emergency department. J Emerg Nurs 2002; 28: 395-400.   DOI   ScienceOn
2 Kahveci FO, Demircan A, Keles A, Bildik F, Aygencel SG. Efficacy of triage by paramedics: a real-time comparison study. J Emerg Nurs 2012; 38: 344-9.   DOI   ScienceOn
3 The Standard Protocols for 119 Emergency Medical Service Providers. Available at http://www.prism.go.kr/homepage /theme/retrieveThemeDetail.do?leftMenuLevel=110&cond_brm_super_id=NB000120061201100060495&research_id=16 60000-201200020 Accessed August 25. 2012.
4 Lehmann R, Brounts L, Lesperance K, Eckert M, Casey L, Beekley A, Martin M. A simplified set of trauma triage criteria to safely reduce overtriage: a prospective study. Arch Surg 2009; 144: 853-8.   DOI   ScienceOn
5 Hauswald M. Can paramedics safely decide which patients do not need ambulance transport or emergency department care? Prehosp Emerg Care 2002; 6: 383-6.   DOI   ScienceOn
6 Richards JR, Ferrall SJ. Triage ability of emergency medical services providers and patient disposition: a prospective study. Prehosp Disaster Med 1999; 14: 174-9.
7 Kirves H, Handolin L, Niemela M, Pitkaniemi J, Randell T. Paramedics' and pre-hospital physicians' assessments of anatomic injury in trauma patients: a cohort study. Scand J Trauma Resusc Emerg Med 2010;18:60. doi: 10.1186/1757- 7241-18-60. Available at http://www.sjtrem.com/content/ 18/1/60   DOI   ScienceOn
8 Kim SC, Lee KH, Lee WJ, Choi HY, Kim HJ. Pilot Study on Construction of a Database for In-depth Analysis of Occupant Injury and Vehicle Damage of Domestic Motor Vehicle Crash Accidents. J Korean Soc Emerg Med 2012; 23: 315-6.
9 Vaca FE, Anderson CL, Herrera H, Patel C, Silman EF, Deguzman R, Lahham S, Kohl V. Crash injury prediction and vehicle damage reporting by paramedics. West J Emerg Med 2009; 10: 62-7.
10 Hasler RM, Kehl C, Exadaktylos AK, Albrecht R, Dubler S, Greif R et al. Accuracy of prehospital diagnosis and triage of a Swiss helicopter emergency medical service. J Trauma Acute Care Surg 2012; 73: 709-15.   DOI
11 Phillips S, Rond PC III, Kelly SM, Swartz PD. The need for pediatric-specific triage criteria: results from the Florida Trauma Triage Study. Pediatr Emerg Care 996; 12: 394-9.   DOI
12 Wuerz R, Taylor J, Smith JS. Accuracy of trauma triage in patients transported by helicopter. Air Med J 1996; 15: 168-70.   DOI   ScienceOn
13 American College of Surgeons Committee on Trauma. Prehospital trauma care. In: Resources for Optimal Care of the Injured Patient 2006. Chicago, IL: American College of Surgeons; 2006: 21-5.
14 Sasser SM, Hunt RC, Faul M, Sugerman D, Pearson WS, Dulski T et al. Guidelines for field triage of injured patients: recommendations of the National Expert Panel on Field Triage, 2011. Centers for Disease Control and Prevention (CDC). MMWR Recomm Rep 2012; 61:1-20.
15 Hunt RC. Emerging communication technologies in emergency medical services. Prehosp Emerg Care 2002; 6: 131-6.   DOI   ScienceOn
16 Townsend CM, MD, Beauchamp RD, Evers BM, Mattox KL. Sabiston Textbook of Surgery. Management of Acute Trauma chapter 18. 19th ed. Philaelphia: Elsevier Saunders; 2012: 433-5.
17 Purtill MA, Benedict K, Hernandez-Boussard T, Brundage SI, Kritayakirana K, Sherck JP et al. Validation of a prehospital trauma triage tool: a 10-year perspective. J Trauma 2008; 65: 1253-7.   DOI   ScienceOn